Induced VBAC News Flash

Specialties Ob/Gyn

Published

  1. Should trial of labor be an option for VBAC?

    • 0
      No, it is not safe based upon this study.
    • 1
      No, it is not safe based upon what I have seen .
    • 0
      Yes, I think it is a right to try labor.
    • 1
      Yes, as long as it does not require an induction with a prostaglandin.
    • 6
      Yes, as long as the risks have been consented and fully explained to the client.
    • 0
      Undecided.

8 members have participated

Greetings All Nurses,

In a recent article I read some very disturbing and misleading text. I would appreciate your interests in this matter. It is public awareness news items like this that sets back VBAC as an birthing option for women. Here is the full text URL http://dailynews.yahoo.com/h/hsn/20..._delivery_after _c-section_1.html (Note ABC News picked up the story for the "Nightly News")

This is the headline "Risk Seen in lady partsl Delivery After C-section" it is very misleading as the opening statement says what the study actually was studying: "Women who've already had a Cesarean section are more likely to suffer a ruptured womb in a subsequent delivery if labor is induced with certain hormone-like drugs, a new study says.

The study of 20,095 Washington state mothers found that uterine rupture is roughly 15 times more common after induction of labor with prostaglandin's than women who have a repeat C-section"

Now we knew this to be true for any women whether they are VBAC, had previous lady partsl births, or are prima's! The fact here is that pitocin and other agents used to augment or induce labor have dangerous side effects! We already knew that but the headline does not say that instead it implies that VBAC is dangerous, very misleading.

The next statement is true but again I see it as a scare tactic "Babies born to women who suffer a burst uterus face a ten-fold increased risk of death in the period surrounding delivery. The findings are reported in today's New England Journal of Medicine" This story makes me wonder who owns these news services, the same corporation as the one who owns the local hospital? There could not be a better advertisement for having a hospital birth or a C-Section than this supposed news item!

In an other paragraph the reader is advised of the risk again for attempting a VBAC "Researchers have known for decades that lady partsl delivery after a C-section can rupture a uterus weakened by scar tissue from the earlier operation. But previous studies haven't been large enough to show whether that risk increases in women who later have labor induced." This type of hype really does set back birthing options for women! how do we as a group oppose and rectify this? I do not have the answer maybe a letter (s) to the editor for the news source. As this appears to be an online article I am not sure who to send it to or if it will be effective or posted! Any ideas are welcome. VBAC have a bad rap and are difficult for many women who are already apprehensive to phantom so why let a story like this off the hook it is full of stats that make it creditable but it is so misleading by the headline and the fact that a woman who is considering a VBAC is less likely to augment or induce the birthing process as they want it to be as nature intended! In the attached message, please read it! There is an e mail address contained in the text to the editor.

This was a posted message of mine at the URL http://clubs.yahoo.com/clubs/columbusmidwifesanddoulas

Titled "OMG Set back for VBAC News Flash" If you have not joined this club look around at the posts and the links, photos and calendar pages. We as a group should be concerned to insure freedom's for birthing options, the Midwifery Model of Care, and research based practice standards. Please read the attached message as it relates to this subject. I have made a poll too for us to voice our opinion of VBAC as a birthing option.;)

[grassrootsnews] gnm 106021 vbac study begs for responses.txt

I hate doctors who still think that repeat c-sections are mandatory. I agree that the opening lines of the study are very misleading. The risk of rupture is still small if labor is natural and I hate inductions anyways as they lead to a higher rate of c-sections and half the women being induced are doing so for convinience rather than safety.

Thanks for this information. I really think those that put things in print should be more responsible for making sure they present facts and not just sensational misleading half-truths. If we all do our part and respond with letters to those who printed this "informing" article maybe we can make a difference.

Carolyn

[email protected]

Together we can make a difference!

Greetings All Nurses,

I would like you to read the article from this URL about a typical C-Section. http://www.birthlove.com/pages/bl_cols/anatomy.html

Is this what you have seen or experienced?

While the site has some good A&P information and the pictures are great, the stats are just plain wrong. I am not a proponent of c-sections because I think they medicalize a healthy normal process, but a recent study showed that c-sections are just as safe as lady partsl deliveries. This site rambles about all these risks of c-sections (20% infection rate? Epidural not blocking paiN? Not in our hospital) but doesn't mention any of the risks that go along with a norrmal labor (like hemmorhage or prolapse, which is associated with vag deliveries too). Women should choose to deliver lady partslly because they want to have a natural delivery and a faster recovery, not because they are subjected to these scare tactics from someone who is obviously biased. I can't stand everyone putting their beliefs on pregnant women. They should be educated with facts and then make their own decision.

so, are the stats from the nejm study wrong ! i quess if your facts are true (fergus51) , then they are fighting fire with fire!:confused:

i do know what a good study is and this was not one, it is invalid and biased from the onset. here is a letter i wrote to the letter editor at http://bmj.com/

in response to thier bmj 2001;323:68 ( 14 july ) news roundup

lady partsl delivery after caesarean section triples risk of uterine rupture by deborah josefson

here is the url:

http://bmj.com/cgi/content/short/323/7304/68

here is the url and the complete text of what i wrote:

http://bmj.com/cgi/eletter-submit/323/7304/68?title=re%3a+nejm+study+is+invalid+and+biased%2c+what+professionals+in+the+field+are+saying%21

nejm study is invalid and biased, what professionals in the field are saying!

i think the response from a physician, on ob/gyn.net sums it all up very well. this is a web site forum discussing this study! here is the url for the complete story!

http://forums.obgyn.net/forums/ob-gyn- l/obgynl.0107/0611.html

by luis sanchez-ramos, md

"...in the nejm, no new information was presented. everyone already knew that uterine ruptures occur more frequently with attempted vbacs than with elective repeat cesarean deliveries (especially in those without labor). everyone was also aware that uterine ruptures occur more frequently with induced labor than with spontaneous labor. the question which was not addressed was a comparison of maternal morbidity in patients delivered by elective cesareans versus attempted vbacs. lydon-rochelle et al did not define "uterine rupture" or attempted to differentiate "rupture" versus "uterine dehiscence" or wound disruption (a combination of both?). the authors simply used the icd code for uterine rupture (antepartum or intrapartum) and relied on whoever coded the birth certificates and hospital discharge data. as everyone knows, this type of information is prone to misclassification and coding errors. lydon- rochelle et al did not review a single chart. they could have easily reviewed the 91 cases with ruptured uteri and certainly the 105 "infant" deaths (they did not define what they meant by infant deaths: up to 1 year of age? perhaps they meant neonatal or even better, perinatal deaths..who knows? were these deaths due to the uterine ruptures or possibly to other causes? in table 4 they show a huge difference (0.5 to 5.5) in "infant" mortality for those who experienced a ruptured uterus versus those who did not. however, of the 91 cases with ruptured uteri, 11 were in patients who had an elective cesarean delivery. did any of these 5 "infant" deaths occur in that group of patients?..."

i have a discussion/poll about this study at all nurses.com https://allnurses.com/forums/showthread.php?threadid=8287

and my club on yahoo at this url:

http://messages.clubs.yahoo.com/clubs/columbusmidwifesanddoulas/bbs?action=m&tid=columbusmidwifesanddoulas&sid=1601038379&mid=54

in addition there are many links from the columbus midwifes and doulas club message board in response to this study called "omg set back for vbac news flash" supporting both what dr. luis sanchez-ramos, md and i have said, including the acnm position on this study!

i hope you consider the facts and the process that which these facts were obtained! the study was biased from the onset by focusing on the vbac and not including information from c-sections that were first time and comparing the data instead it focussed on the vbac option, without supporting the facts that this occurs with lady partsl and emergent deliveries post induction with a prosaglandin! i hope you consider redrafting this news item for it true value, useless!

thank you in advance, james ullman, lpn, cbe, doula

Specializes in Perinatal/neonatal.

My reply to this thread is a personal one. My opinion is based mainly on these experiences. I had a cesarean for the delievery of my first child after a "faliure to progress" diagnosis was slapped in my face after 28 hours of induced labor. The reason I even agred to be induced was because I was 19 and not yet a nurse myslef. I was told that I was two weeks overdue and that "the baby was just getting fat now". I did dialate completely and pushed for half and hour. Still no baby, so I agreed to do the c-section. I was in such enormous pain and the naval hospital in Millington did not give spinal anesthesia. I was given Demerol and Stadol while in labor. A HORRIBLE EXPERIENCE (but a beautiful 9.8 lb. baby boy!) Anyway, when I was expecting my second child and reached my due date (May09'95) and I still hadn't delivered, I asked for another c-section after the doc suggested that I be induced. I refused to go through THAT again. Besides, my husband was out to sea and I was alone and I couldn't have dealt with that by myself. When I delivered my baby he weighed 10.9 and the doctor was so relieved that I opted not to go with the induction. (Jared was so big that he had a difficult time removing him from me) I am glad that I refused the induction even though I had to have the surgery. Now that I am a nurse, I feel I made the best choice for myself, too. Note* When I applied to nursing school and required a full physical I was able to have a good look in my medical record. Come to fine out, my first son wasn't even overdue! He was born via cesarean on his DUEDATE after a 28 hour induced labor. GEEZ. The big babies just run in our family.

Jami,

I don't know exactly what I said that you take issue with. To make myself perfectly clear I think the original study about VBAC and the following media hype are absolutely ridiculous and misleading. Women can safely have VBAC and the fact that so many women are induced unecessarily is the real problem in my opinion.

BUT, that site you posted about a woman's personal experience with a c-section was just as biased. Like I pointed out it doesn't mention any risks associated with vag deliveries and the stats are just as alarmist and misleading as the VBAC article's were. Like the 20% rate of infection which she points out is a leading cause of maternal death (I have never seen a mother die from infection at the hospital I have worked in for the past 4 years). Our hospital does not have nearly that high of a rate, and what does she mean by infection? Is she talking about a little redness around the incision or is she talking about sepsis? She doesn't say, rather she just points out how dangerous infection is. VERY MISLEADING. In fact, it's just as misleading as the study saying VBAC is unsafe. She also says things like a c-section is "highly likely in any hospital birth" while ignoring the particulars. Sure your chance of getting a c-section is higher in a hospital, but mothers can deliver in hospital and direct their own care. She also says that after a c-section women are more likely to be induced in subsequent labors. THEY DON'T HAVE TO BE. Women can become informed and direct their own care. They are not helpless children. That is what I objected to on the site.

Women need to be given facts PERIOD. Personal experiences and scary stats can be found to discourage anything (VBAC or c-setion). THEY should be able to make their own decisions free of these scare tactics and intimidation from professionals who are obviously biased.

By the way Jami,

Stats can be perfectly correct and still be misleading. Perhaps that's the wording I should have used in my post about the website in the first place.

Originally posted by fergus51

By the way Jami,

"Stats can be perfectly correct and still be misleading. Perhaps that's the wording I should have used in my post about the website in the first place." "Women need to be given facts PERIOD. Personal experiences and scary stats can be found to discourage anything (VBAC or c-setion). THEY should be able to make their own decisions free of these scare tactics and intimidation from professionals who are obviously biased."

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Yes esp. when they do not include all group in the study! Now there is one stat you can not deny that you mentioned from the page I posted about C-Sections, it is that our American Medical Model of childbirth has a C-Section rate of >20%:eek:

I agree totally with your second statement and I must say that Humans have a built in biased thought process! But I too try to present facts and let the client choose, without my personal thoughts being involved.

:rolleyes:

I again would like you to read a page dedicated to this study. Here is the details: :p Standing up to the VBAC-lash:

A critique of the New England Journal of Medicine VBAC study and implications for the future of the medical model of childbirth

by Jill MacCorkle

Jill is the founder of ICAN! The URL is

http://maccorkl.home.sprynet.com/VBAClash.htm

Originally posted by NurseAngie

My reply to this thread is a personal one. My opinion is based mainly on these experiences. I had a cesarean for the delievery of my first child after a "faliure to progress" diagnosis was slapped in my face after 28 hours of induced labor. A HORRIBLE EXPERIENCE (but a beautiful 9.8 lb. baby boy!) I asked for another c-section after the doc suggested that I be induced. I refused to go through THAT again. When I delivered my baby he weighed 10.9 and the doctor was so relieved that I opted not to go with the induction. (Jared was so big that he had a difficult time removing him from me) I am glad that I refused the induction even though I had to have the surgery. Now that I am a nurse, I feel I made the best choice for myself, too. Note* When I applied to nursing school and required a full physical I was able to have a good look in my medical record. Come to fine out, my first son wasn't even overdue! He was born via cesarean on his DUEDATE after a 28 hour induced labor. GEEZ. The big babies just run in our family.

WOW!:eek: BIG BABIES!:rolleyes: How much did you gain during the pregnancy? Did you return to the pre pregnancy wieght? So for you the option of a VBAC or even a lady partsl delvery the first time was not viable! Is this what you tell clients now? I mean do you advocate that a section is better than the way nature itended?:confused:

I will say that whatever method of childbirth is utilzed it is the RIGHT;) way if the Mother is informed and opts for whatever! I support your choice, but do you now say that a section is better than a lady partsl? As far as inductionsgo, to me they can go out the window as an outdated procedure filled with to many risks and ending in more interventions all the way to a section. You just make that point stronger!:D

Congradulations on having your second child the way you wanted and for surviving the first LOL!

Peace,

Have a Blessed Day,

Jami

Thanks for the link Jami. I have read the VBAC study (along with all the other nurses on my unit) and believe it is not worth the paper it is printed on. The issue is particularly contentious in our hospital because we have a notoriously high c-section rate, even higher than the other hospitals in the province (20% would be a real decrease for us). We have found some simple guidelines from research that should be followed to reduce the number of unecessary c-sections and are attempting to implement them. We want to demedicalize this healthy process. We need to educate women on how to have a safe VBAC (notice I say how to have and not whether they can or not because I believe that most women can have a safe VBAC).

I tend to be biased towards a more natural childbirth like you, but I know I have to just listen to the mother. If she wants an epidural or a repeat c-section and is aware of the risks, I know I can't make the decision for her. I have a duty to advocate for my clients, not dump my beliefs onto them.

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