VBAC Article Link

USA987, MSN, RN, NP · Aug 26, 2005

I have seen both sides of VBAC's...several successful deliveries, but one horrible rupture.

I really don't mind being the nurse taking care of VBAC's as long as we adhere to the guidelines set forth by the hospital. I can't lie though. I am concerned about these high-risk women delivering at home...

TweetiePieRN · Aug 26, 2005

I had a c-section with my baby and I do not plan on attempting a VBAC for the next one. I don't feel like less of a mom by having surgery, nor do I feel I need to "prove myself" by having a vag delivery. To each their own I guess. :wink2:

FrumDoula · Aug 26, 2005

I had a c-section with my baby and I do not plan on attempting a VBAC for the next one. I don't feel like less of a mom by having surgery, nor do I feel I need to "prove myself" by having a vag delivery. To each their own I guess. :wink2:

It has nothing to do with proving oneself. It has to do with safety, as well as women having the fullest range of safe options. Insurance companies should not dictate care to physicians. Nor should women be scared into having a c-section, as they often are.

lady partsl delivery is generally the safer option all around. VBAC is not without risks, but neither is a cesarean, and I get rather tired of people assuming it's risk-free. (And physicians presenting it as such.) I also get tired of women being scared out of the VBAC option, when the research shows that it's safe.

Anecdotal evidence is all well and good, but give me a decently done study any day of the week. I'm sure the RN's on here have seen the good, bad and ugly with each option. Ain't no perfect option.

But women are getting scr*wed right now out of a perfectly legit birth option. And we are heading back into "once a c-sec, always a c-sec" mentality. A 27% cesarean rate is just horrible.

Is a woman who is VBACing considered to be "high risk" by ACOG standards? There are midwives in my area who will do VBAC homebirths. I'm not sure it's any riskier, statistically speaking, than the risks from a guaranteed cesarean delivery at a local hospital.

SmilingBluEyes · Aug 26, 2005

I think the insurance companies are the entities you need to argue with, not us nurses.

I think VBAC SHOULD BE an option, I really do. You don't have to sell me as an OB nurse---------however it's harder each day to have this option open-----too many liabilities ------and too many people will sue a the drop of a hat if/when something goes wrong, despite "informed consent". Often these are not worth the paper printed on in the court room!

midwife2b · Aug 26, 2005

I think the insurance companies are the entities you need to argue with, not us nurses.
I think VBAC SHOULD BE an option, I really do. You don't have to sell me as an OB nurse---------however it's harder each day to have this option open-----too many liabilities ------and too many people will sue a the drop of a hat if/when something goes wrong, despite "informed consent". Often these are not worth the paper printed on in the court room!

We've come full circle and then some on this issue...

In 1996 my sisters insurance company notified her that she HAD to attempt a VBAC; they WOULD NOT UNDER ANY CIRCUMSTANCES pay for a "repeat". This letter came 2 weeks before her scheduled repeat C-birth. We were shocked. I had checked my sister in labor with her first and she couldn't get a 3 lb. baby out of that pelvis (she was 6 cm. for 6 hrs. and her first was 6 + 4 with some pretty bad moulding and direct OA... not like she didn't try)

She hysterically called her OB and I don't know what he wrote to the insurance company but a week or so later she got a letter stating her previous records were being reviewed. They took the plunge... it did get covered... This baby was 7 + 12 and I can't even imagine what she would have gone through... or whyintheheck she would have to!

Choice is so important! Despite what you personally believe about VBAC it should still be discussed at length with the patient. And if the woman doesn't like what she hears she should find another doc or midwife!

One of our solo OB's won't do a VBAC at all. Last week in comes one of his patients with the head on the perineum. She never called him to say she was in labor; come to find out she had a friend check her cervix and they timed the entire thing so she would avoid a C-birth. The doc missed the birth (of course) and yelled at everybody (like we were in on the plan?!?) I hear this situation happening more and more and IMHO its dangerous, scary and definately not my favorite situation to be in!

midwife2b · Aug 26, 2005

Anyway, here's the article. Those of us in the birth world could see this battle coming a mile away, and it's only a matter of time before women begin suing to have a VBAC.

Some of us are out there, doing what we can, to protect that FIRST lady partsl birth...

SmilingBluEyes · Aug 26, 2005

And some of us are dealing with the fallout from both sides.

Being caught in the middle is not fun, as you may imagine.

And unless and until people are held to their RESPONSIBLITIES as well as given their RIGHTFUL choices, it will continue to be a huge battle as to whether VBAC is "allowed" in a given hospital or not. In other words, the informed consents need to HOLD UP IN COURT.

Sleepy_Princess · Aug 26, 2005

Unfortunately, I don't think the fact that VBACs aren't allowed in most hospitals really matters. I think there is a growing group of mothers who feel so bullied and helpless that they wouldn't want to give birth in a hospital even if they could. Personally, I was TOLD I had to go in for an induction. After 12 hours of labor, I was TOLD that I wasn't progressing fast enough and that I HAD to have a c-section. I was fine, the baby never showed any signs of distress, but my time was up. It wasn't my fault that I had a medically unnecessary procedure because my ob/gyn didn't have time to wait for me. I don't think I should be punished because I didn't fight hard enough to preserve my ability to deliver lady partslly. When the time comes again, I will be taking my chances in a birthing center because I just don't trust ob/gyns anymore. It isn't about having something to prove; it's about having control over your own body and replacing a bad memory with a good one. Wow, I didn't realize I had become so militant about this issue! :lol2:

SmilingBluEyes · Aug 26, 2005

Feeling bullied and pushed around is a very valid concern and complaint.

I have found however, the most educated couples are not about to be bullied about. This is a good in my opinion.

Knowledge is indeed power. And a loss of power/sense of helplessness is all-too-common in the obstetric environment for birthing families.

I don't blame people for seeking alternative options. I am glad they exist. I wish things were not how they are today, myself. It's a very complex issue.

imenid37 · Aug 26, 2005

Not necessarily R/T VBAC, but I feel some pt's and families want to bully us. I am not talking about people making an informed decision we don't agree w/. I am talking about "support" (I use this term loosely because they are often not truly supportive) who try to "run" the show. Ex. folks who blame us for things like talking pt's into epidurals, (many pt's hit the door and want the epi w/o any input from us) because the "support" person is anti-epidural. Also there is the age old problem of pt's who recieve advice or info. and claim they have not been given the info. or that they were told just the opposite of what they were told. Example: pt. several days ago comes into to deliver. Never had her GC tx'd which she had presented w/ to L/D triage several months ago because she was "told by a nurse" no one at this hospital will see you for prenatal care here. She didn't know the nurse's name or remember what she looked like. She just knew no one would be available to care for her, so she did not try to find anyone. She also wanted a ____ing epidural and her "support" person said she should sue us because she delivered too rapidly and was "traumitized" by having to put up w/ pain we did "nothing" about. of course I don't take the lawsuit thing seriously but I also don't think those of us who are trying our best to help a non-compliant pt. should have to put us w/ this type of bullying. I think civility in dealing w/ each other is moving way off to the wayside. The liability issues we face have a great deal to do w/ how we and the pt's seek to "bully" one another.

The VBAC debate is about 5% science and 95% money IMHO. Insurance companies want to control men, women, children, doctors, nurse, and therapists. They provide a non-discriminatory equal opportunity disservice to almost everyone. Many pt's and support are semi-informed and so are some of us providers of care.

I will have to ask about the breast manipulation. Most of our ob docs are DO's.

SmilingBluEyes · Aug 26, 2005

Not necessarily R/T VBAC, but I feel some pt's and families want to bully us. I am not talking about people making an informed decision we don't agree w/. I am talking about "support" (I use this term loosely because they are often not truly supportive) who try to "run" the show. Ex. folks who blame us for things like talking pt's into epidurals, (many pt's hit the door and want the epi w/o any input from us) because the "support" person is anti-epidural. Also there is the age old problem of pt's who recieve advice or info. and claim they have not been given the info. or that they were told just the opposite of what they were told. Example: pt. several days ago comes into to deliver. Never had her GC tx'd which she had presented w/ to L/D triage several months ago because she was "told by a nurse" no one at this hospital will see you for prenatal care here. She didn't know the nurse's name or remember what she looked like. She just knew no one would be available to care for her, so she did not try to find anyone. She also wanted a ____ing epidural and her "support" person said she should sue us because she delivered too rapidly and was "traumitized" by having to put up w/ pain we did "nothing" about. of course I don't take the lawsuit thing seriously but I also don't think those of us who are trying our best to help a non-compliant pt. should have to put us w/ this type of bullying. I think civility in dealing w/ each other is moving way off to the wayside. The liability issues we face have a great deal to do w/ how we and the pt's seek to "bully" one another.
The VBAC debate is about 5% science and 95% money IMHO. Insurance companies want to control men, women, children, doctors, nurse, and therapists. They provide a non-discriminatory equal opportunity disservice to almost everyone. Many pt's and support are semi-informed and so are some of us providers of care.
I will have to ask about the breast manipulation. Most of our ob docs are DO's.

that is very true. I had the MOTHER of all master manipulators in a VBAC situation some time back. It was horrendous. And throughout her miserable course (baby unfortunately wound up in nursery) she threatened to sue us all.

Mind you, nothing we did was wrong----it was just her way of trying to exert control. Ironically, I bonded well w/the lady and her family----we did fine. Until the baby went to the nursery. That is when all heck broke loose and no one, not even her trusted family ped (who took care of this baby), could do a thing to appease her.

It was disruptive and dangerous, from a medical and legal standpoint, this very case. Talk about a nightmare..... Even other patients heard her screaming rants from their rooms and asked what was going on.....what a horrible time.

There are times when it seems no one can win.

And you highlight why I think the insurance companies are at the very root of many of our problems to day, in nursing and medicine. I really believe this.