Please welcome a new contributor who’ll be sharing her brilliant mind with us every so often here on The Shopping Mama. Malia is a fellow Air Force mom who recently moved to Florida (near me!). She blogs at The Jack Effect, a blog about babies, cloth diapering and all that her young son brings. Please welcome her, chime in here and check out her blog (where you can find a more in-depth post on the new VBAC guidelines).
***
Like a lot of women, when I reached month seven or so of my pregnancy I started to consider how the little guy was going to get from point A (my tummy) to point B (my arms). The doctor thought there was a chance I would need a c-section if he was a big baby, so a c-section was definitely on my radar. I wasn’t excited about the idea, but I was open to whatever needed to happen for a healthy baby. By the end I was ready to just schedule an appointment and get my baby out whatever it took! After 12 hours of labor and an amazing nurse and doctor I got my baby and no c-section. It wasn’t until I was home recovering that I realized how blessed I was to have a vaginal birth.
Not every mama gets the chance to have a vaginal birth when she hopes. For thirty-one percent of women in the US the end result of pregnancy is a c-section (in 2007). For some this is their birth plan and what they wanted or needed for their own or their baby’s health. For others it is a disappointment, an ending not at all in their birth plan. For these women, a recent update to the Vaginal Birth After C-Section (VBAC) guidelines published by The American Congress of Obstetricians and Gynecologists (ACOG) may be welcome news.
New ACOG Guidelines on VBACS
ACOG’s newest guidelines stress that VBACs should be an option for most women including those with one or two prior c-sections, carrying twins, or arriving to deliver where an emergency surgical team in not immediately available (such as a small hospital).
ACOG has put the emphasis back on mom’s choice—as long as it’s an informed one.
ACOG hopes their new guidelines will help reduce the number of c-sections over all. In the 70’s our mothers helped make VBACs more commonly accepted and VBAC rates rose until the mid 90’s. Then, in the past half a decade, there has been a dramatic decline in VBACs. This decline has been linked to restrictions from insurers and hospitals afraid of being sued and decisions made by moms worried about the risks of VBAC. Pregnant women and doctors are worried that the surgical scars from a c-section could increase the risk of uterine rupture and bleeding, something that can be extremely dangerous for both mom and baby. Additionally, while a vaginal delivery after a c-section has been shown to be safer than a repeat c-section, a c-section after a failed VBAC is more dangerous than a scheduled c-section. It may help women to know that ACOG has found that there is less than a 1% increase in uterine rupture in VBACs and that the majority (60-80%) of women trying for vaginal birth after c-section succeed. I’m not sure I would be willing to take the risk, but I’ve never dealt with c-section recovery.
What do you think? Would you consider a VBAC? Do the new guidelines change your opinion?
Cindy
July 29, 2010I just posted about this at my blog yesterday. Unfortunately, the cogs of bureaucracy move slow, and our hospital hasn’t quite got the message yet. They refuse to allow me to plan a trial of labor. Really annoying, but at least I have access to a better hospital and doctor who are a little more sensible. I just have to drive an extra hour to get there.
Here’s the link, if you’re interested: http://getalonghome.com/2010/07/pregnancy-update-this-time-with-a-rant/
Jennifer Lanning
July 29, 2010I am hopeful that I will be able to try VBAC the next time around. I only agreed to a c-section at the last minute for the health and safety of my daughter. It has been a hard and emotional recovery so far (5 weeks). If we have to do another c-section, it will limit the number of children we have (due to the trauma, recovery, health issues, etc.).
Congrats on the birth of your little one! I am sorry your recovery has been rough – hang in there, it will get better.
Jennifer, Congrats! So sorry to hear it’s been rough for you. Check out this link that includes Michelle Duggar’s comments (from “19 kids and counting”). She and her doctors haven’t let c-sections limit her
http://www.foodconsumer.org/newsite/Non-food/Miscellaneous/vbac_policies_should_they_circumvent_mom_s_wish_072220100905.html
Oka
July 29, 2010I fought to have my last one VBAC and they would not let me because I had C-section, VBAC, and another C-section. I’m glad women will be allowed to make that choice.
nancy
July 29, 2010Hello!
This topic is near and dear to my heart! Our first son was born via c-section at 28 weeks, and we are just thankful he is alive (my water broke at 17 weeks and we were told he would not make it, but that’s another story)! After 2 miscarriages, I got preggie again, and we found out it was twins. Praise the Lord, we found an older doctor (who was trained in breach birth) and had a successful VBAC. I would recommend this to anyone and everyone who has this option. My recovery was soo much better and easier and faster. I felt “with it”, was able to hold my babies, and was able to be up and about right away
That said, don’t feel like a failure if it doesn’t work out for you- you still gave birth (even if it was a different way than you planned) and are no less of a person- and, Lord willing, you have a baby. Focus on what really matters- don’t have regrets!
His,
Nancy
Kate
July 29, 2010I was lucky to have easy vaginal births with both my kids.
The new recommendations sound like a good step in the right direction for lots of moms and I hope doctors get on board and respect women’s choices.
Ellen - TC Mom
July 29, 2010I have several friends who have had VBACS or attempted them. The problem is due to insurance issues many doctors cannot even attempt VBACS they will not be covered. My doctor will allow you to attempt a VBAC if he did the C-Section and is confident in your healing that you are strong enough to handle it. I think that is a good approach since there are still risks that your muscles are too weak. Now that being said I have been very blessed to have 3 natural births and have not had to experience the emotional roller coaster that an emergency/unplanned c section brings. I think it is fantastic that women are given more choice and hopefully insurance will recognize this choice more as well.
I was just going to bring up this issue… I think doctors (particularly OB/GYNs) make decisions based on what’s “safest” – meaning, the least risk of a lawsuit. It will probably take a while for recommendations like these to catch on for insurance companies and doctors to really embrace the idea of more VBACs.
Ellen - TC Mom
July 29, 2010Nancy great point about focusing on the baby and that miracle! I had a friend attempt a VBAC and she almost lost the baby so just be sure you are aware of the risks. Have a doctor you trust and a plan for how long you are willing to try and when you need to just do the c section. My friend was so focused on it had to be a natural delivery that she ignored her doctor and it almost ended badly.
Annie
July 29, 2010I am so glad they are releasing this statement. I live in Kansas and very very few doctors will attempt VBACs. I hope this helps insurance companies be more accepting of them.
I like that they said a VBAC is safe even after multiple c-sections.
I have had 2 c-sections so far and healing times from both have been awful. My first was an emergency as Lizzie was breech and no one knew it.
I attempted a VBAC with a midwife with David but my water broke and 36 hrs later I was only dialated to a 3cm. Nancy was right – I cannot regret my lack of vaginal birth but I can be supremely happy he was born healthy and I healed well without complications.
Deep inside I wish I could have a natural birth someday. No midwife or dr. will allow a VBA2C, not around here. Sad when you read that statement above.
Missy
July 29, 2010Hi! I had an emergency c section with my first daughter after nearly 18 hours of labor. She wasn’t coming out! It was a horrible experience because the labor was intensive and by the time they did the surgery I was exhausted.
9 years later I got pregnant again and I did talk with my OB about it, she said it was ultimately my decision to go for the VBAC but I was worried about the risks. I know that the chances for post procedure are lower but it was still too high for me, I opted for another c section and in 2 days I was up and moving around pretty good!
I think it’s a good thing that women have the choice as long as they are informed. It’s very important to trust your doctor AND do a lot of research yourself!
Karine Traverse
July 29, 2010I attempted a VBA2C in March and while everyone there (midwife, my nurse and the on-call OB) were all for letting me continue to labor it was a nurse that lied to us which resulted in us deciding to go with a repeat.
I had been laboring all day at home for about 10+ hours at this point and only an hour in the hospital. This nurse came in and told me there was a window on my uterus during my last u/s only days earlier and that the pain got so intense so fast because I was near rupture. She said they would leave us to decide and check me before I gave them our decision. I never got checked again, but instead had this nurse pushing paperwork on me. I figured they really were worried about me and baby so I signed and had my beautiful little girl less than an hour later. While on the operating table this same nurse said the doctor only had to poke open my uterus with her finger. Upon my post-op visit I found out the nurse was lying and none of what she said was in my report. Makes me wonder did this nurse just not want to deal with me laboring until her shift was over knowing I had woke up in labor at 11am and it was already 11pm?
What does this mean? I am now 3 c-sections in and I will fight tooth and nail to have a VBA3C when we decide to have our next child.
Thanks so much for posting this, I already made my decision, but this makes me feel even more confident in it.