why the anti-VBAC stance in hospitals?

Jolie, BSN · Mar 30, 2003

I just want to clarify one point from SwnymtnRN's post. The 1-2% statistic I've quoted is not a VBAC failure rate. It is the risk of uterine rupture with healthy VBAC patients.

Best of luck to you and your baby.

parker in arkie · Mar 31, 2003

Quoted from "The Birth Book" by William and Martha Sears, M.D. and R.N. respectively

Twenty or more years ago cesarean sections were performed with a vertical incision made in the upper part of the uterus-the area most prone to rupture. Today the incision is usually made horizontally in teh lower part of the uterus. This type of incision is highly unlikely to rupture. If a mother had a low-transvers incision, VBAC authorities now estimate the risk of uterine rupture in subsequent labors to be around 0.2 percent, which means that a VBAC woman has at least a 99.8 percent chance of going through labor without rupturing her uterus. In a survey of 36,000 women attempting VBAC, no mothers died of uterine rupture, regardless of type of prior uterine incision. Researchers studying the medical literature on VBAC over the last 40years found that not a single mother died from rupture of a scarred uterus. (But mothers have died due to complications of repeat cesarean sections.) In a study of 17,000 women attempting VBAC, no infants died as a result of uterine rupture. In the rare case that a scar does pull apart, it does so gradually and incompletely. Considering that the estimated risk of death from cesarean section is around 1 in 1000 (2-4x that of a lady partsl birth), there is NO REASON to advise a mother to have a repeat cesarean section because of the risk of uterine rupture. """"

If you are really interested in VBAC, I would advise reading "THE BIRTH BOOK" by the Sears and "THE THINKING WOMAN'S GUIDE TO A BETTER BIRTH" by Henci Goer. Both are excellent books. Also, if available, speak with a Bradley Method of childbirth teacher. And interview doctors until you find one that WILL SUPPORT YOUR BIRTH.

You will remember this birth forever. Your doctor will likely forget it by the end of the year.

Good luck l e mae!

HazeK · Mar 31, 2003

re: quote from previous entry: "... In a study of 17,000 women attempting VBAC, no infants died as a result of uterine rupture. In the rare case that a scar does pull apart, it does so gradually and incompletely...there is NO REASON to advise a mother to have a repeat cesarean section because of the risk of uterine rupture. "

OK, I don't have percentages or numbers....

I have 22 years in L&D....

I work 3-4 days per week on a unit that does >400 del per month....

and I must disagree with Dr & RN Sears!

VBAC has its risks and anyone would be foolish to underestimate them!

I have been in C/S where the baby is floating in the abdomen, having gone through the ruptured uterus!

I have seen CPR done on comprimised infants that have exsanguinated when the placenta sheared off because the rupture was by the placenta.

I have seen women go to ICU after massive hemorrhage from a ruptured uterus requiriing a mega-transfusion.

I have counseled families after the death of their child secondarty to a ruptured uterus......

AND THIS HAS HAPPENED IN A FACILITY THAT CAN PULL OFF A C/S IN 5"-10"!

be cautious, be safe....and more than likely, you will beat the odds!

hugs

haze

Long Term Care Columnist / Guide · Mar 31, 2003

Wow, how things have changed in the past 15 years.......I had a perfectly normal, completely unmedicated lady partsl birth after TWO C-sections, an 8 lb.2 oz boy who was so alert in the delivery room that he held his head up and looked around. And this was when I was somewhere around 280#, with a history of HTN and long labors. I guess none of us knew then what a risk I was taking in trying for a VBAC; but I'd do it all over again to avoid the surgery and the subsequent infections I got afterwards. (One of which was so severe I could have died; as it was, I was ill for most of my third child's first year of life.) My last child, born in 1991, ended up being delivered from above, but that was only because he was nearly 11 lbs. and 23" long!

SmilingBluEyes · Mar 31, 2003

I guess it all comes down to INFORMED choice. The pro's and con's of each option to be weighed carefully and that informed choice respected to the utmost once made. I, personally am not here to change minds or sway anyone but I darn sure would want standard of care met wherever I chose to give birth and my consent to either proceed VBAC or with Repeat Csection to be THOROUGHLY discussed and indeed just that, INFORMED. That is what it's about. Then we leave it up to our patients/families to decide how best to proceed. That is the best we can do as nurse patient advocates. That is what I see here in this thread, for the most part.

Anagray, BSN · Mar 31, 2003

Do you think that the risk of uterine rupture can also depend on how well the patient has healed and how long it's been since the previous pregnancy?

My C-sec was done over 4 years ago, I can hardly see the scar on my stomach and I heal well in general. If anything was different, I probably would not even attempt a VBAC for my next.

Also, l.e.mae, what was the reason for your C-section?

Congrats, btw. I'm also faced with a VBAC and I received a lot of infromation in my post about epidurals below.

l_e_mae · Apr 1, 2003

sorry I haven't replied...sooooo busy lately!

some background info...my 1st labor was induced with pit., had my water broken after 3 hours, still didn't feel a contraction (but they were registering on the monitor) for 6 hours, after 11 hours of labor, and at 6 cm, got an epidural, then nothing....flat line on the contraction chart.....they already had my pit. up as high as they could, so what to do? they waited 5 more hours and I had minor contractions which ultimately got me to 7cm dilated (mind you, the nurse made me lie flat on my back the whole time)

then, the nurse came in and told me (this is after 16 hrs. of labor) that the baby wasn't doing good and I had to have a c-section immediately, the doctor was on his way. 30 minutes later, the doc walks in (at 11pm) and I vaguely remember him saying something about walking around and getting in the hot tub (since I have not been allowed out of bed all day--even to pee, I was forced to use a bedpan) then someone (my husband?) said whatever is best for the baby and I said "ok" so, out they wheeled me and 3 hours later I was able to hold my baby (at 2am) after my c-section.

yes, I am still very bitter about the whole thing....still not quite sure where everything started going wrong but it's too late to change everything now.

so, to answer the question about why I had a c-section...your guess is as good as mine...failure to progress? epidural meds up too high and stopped contractions? pitocin has no effect on me? psycho nurse that wanted to witness a c-section? (just kidding on that one)

I have done a considerable amount of research on the risks of c-section and the risks of VBAC/uterine rupture and I am aware of the risks to myself and to my baby. I am also aware of the benefits of a lady partsl delivery to myself and to my baby, and I feel that these outweigh the risks.

The hospital that I delivered my son at (and the one I am planning on going to this time around) has an OB-GYN in the building at all times, as well as an anesthetist and 2 ORs just for the OB floor. So, I don't see what the problem is there.

I understand that in this country, everyone is all too happy to sue any doc. that gives them an outcome less than perfect. but in the case of VBACs, why can women not make a decision about their bodies if they are informed enough to consent? Why are they forced to choose a surgical procedure over something natural? I mean, if I walked into the hospital, 40 wks, and in labor and refused to sign any type of consent form for a c-section, I'm sure I would receive sub-par attitudes from all involved.

I'm not trying to be difficult...I promise!! I just wish that I could make up my own mind without the hospital officials doing it for me. my only other option (right now anyways....and I know, I'm jumping the gun...I still have 30 weeks to think about this) is to go to another hospital that allows VBACs and the closest one is over an hour away.

Thank you all for your replies and your well-wishes!

I think that I have now made up my mind to try for a VBAC. And, I will be sure to ask the doctor and the hospital about many of the issues that you all have brought up. I may have to go out of town to another hospital to have my wishes met but I will now be sure that they are prepared to do a c-section if need be.

Thanks again--l_e_mae

mark_LD_RN · Apr 2, 2003

anagray it does have to do with the type of incision how well it has healed and length of time between deliveries. atleast 18 months is the crirteria we use here.

I am i full support of VBAC's and think it is a shame that it is frown upon by many. i think that is mostly due to the threat of litagation.so now every one has to pay the price:(

unikuelady, RN · Apr 3, 2003

I delivered my 3rd child VBAC in a hospital that had 24 hour in house coverage,(anesthesia, ob md, OR available for crash C-sections). This hospital was part of the study to determine if VBACs were safe. Requirements to have a VBAC were as follows:

No pain medications. No epidurals. No pitocin.

Must have IV access.

Once in labor not able to change mind and have c-section unless medically necessary.

1st c/s due to term breech presentation. (military hospital) 7'15"

2nd due to mandatory repeat c/s. (same military hospital). 8'6"

3rd baby. 9lb 8oz. VBAC baby ok. mom bad shape. I ended up having a fractured pelvis (yes it can happen with delivery), severe tearing/laceration on lady partsl vault. large episiotomy. hemorrage, it took the ob surgeon 3 hours to put me back together. Thank God I was in a facility that had immediate backup.

The interesting thing is my uterus and cervix were in great shape. The MD said the complications to me were due to the unexpected large size of the baby and precipitous delivery.

Would I do it again? I don't know. that was my last baby. This all happened in 1985 in So California.

Would I do it again? I never found out.

The bottom line is weighing the risks and having a healthy baby.

The ACCOG guidelines are there for a reason. I was one of the study participants.

Good Luck

RMH · Apr 3, 2003

How funny things change..When I delivered my 2nd child 13 years ago I wanted a c-section but she came too quick and a day early. I was suppose to pay for the stand-by OR crew, but they had another emergency c-section, so I lucked out. ( I still wish I had the section though, couldn't sit for a week lol) I wasn't an OB nurse at that time. When I started working where I do now we had v-bacs sign a consent, about 6-7 years ago we threw them out. Now with the current trend should we do a consent again if someone really wants the v-bac and meets the criteria mark states? I guess I need to do more research.

Randi

ayemmeff · Apr 3, 2003

Originally posted by RMH
( I still wish I had the section though, couldn't sit for a week lol)

Oh,poor you!

Recovering from a c-section isn't exactly great fun either.

l_e_mae · Apr 3, 2003

thanks for all the great replies!

as for recovering from a c-sect., I couldn't stand up, sit up or bend over without assistance for a week...I think I'd rather not be able to sit:)

I visit babycenter quite often and a women there had an interesting post. She said that if a hospital isn't equipped to handle a uterine rupture and emergency section, how would you possibly feel comfortable delivering any baby there? the risks of prolapsed cord, and other needs for emergency sections must be comparable to the risk of uterine rupture.

just thought I'd throw that out for thought!