Picking up on my passion for VBACs lets start with some little known facts, or at least the ones not mentioned by your provider. “The risks to repeat cesarean sections”. My intent is not to bash the Medical Model of Care or those who follow it, there are many vbac supportive MDs, OBs and CNMs, but sadly the *majority* do not support vbac, which is not evidence based. I plan to focus on the risks of RCS, the benefits of vbacs, what a vbac after 1 cesarean can do, your rights as a childbearing mother, and your options for birth and choosing care providers.
What led to the National average of 32.8% or 1 in 3 women(current 2012)? A rising liability insurance costs for doctors who allow vbacs ? A ban on vbacs by hospitals due to the necessity of having an OR team ready 24/7? Women not knowing they have the option to vbac? A very unsupportive society? Most likely a combination of all of those issues. It is true that your rupture rate does rise a little bit after you have had 1 prior cesarean(.87% chance during first vbac) , women are told that every day they ask to try for a vbac. However, they are not told that you have a chance of rupture in your first birth with NO prior cesarean. The risks of a repeat cesarean:
Risk of hysterectomy : 0.42% (1 in 238)
Risk of blood transfusion: 1.53% (1 in 65)
Risk of Placenta Accreta: .31% (1 in 323)
Risk of major complications: 4.3% (1 in 23)
Risk of dense adhesions: 21.6% (1 in 5)
*These risks go up after each repeat cesarean
Chances of successful vbac: 63.3% (2 in 3)
Risk of uterin rupture: .87% (1 in 115)
Risk of hysterectomy: .23% (1 in 435)
Risk of blood transfusion: 1.89% (1 in 53)
* your chances go up for succesful vbac and your risks go down after each succesful vbac
All mothers should be given the chance to attempt a vbac, allowing labor to start on its own and be free from bullying for their choice to lower risks to mama and baby. At the end of the day it is the mother and baby who live with the cesarean , the risks that come with it and the emotional burden a RCS with out choice can bring. Women were created to give birth vaginally, sometimes we have real emergencies and life saving surgery is necessary, but a RCS for the sake of liability and convenience is harmful for out Maternal and Newborn safety.
Some women are threatened with a RCS, some are coerced ( your baby will die, we will call CPS etc) and some are flat out told that a vbac is not possible. As we have seen most recently on social media and in the news, the story of Jennifer or the #Jenniferisnotalone, this mother was sent a letter saying she would have a cesarean “with or without her consent” her full story can be found here. It does happen. With how our maternity care system runs, what the heck can be done to avoid an unnecessary RCS?
As a pregnant women you have rights and I highly encourage you to become familiar with them. If you have the “right to refuse any test or procedure” then you have the right to decline a scheduled RCS before you are given a Trial of Labor, a chance to labor for a vbac. You have the right to choose your care providers, fire and hire new ones if they become unsupportive.
Be sure that your chosen care provider is vbac supportive not just vbac friendly. If they seem very supportive in the beginning of your pregnancy, and slowly start to lean towards scheduling a RCS or saying things like ” your baby seems big” ” I want to schedule a RCS just in case” “you have to labor with an epidural, just in case” “you dont need a birth plan” then you may want to look for a new care provider. Those are some basic red flags that your care provider will back out in the moment and “coerce” a RCS on you. Spend lots of time researching the TYPE of care provider you are hiring. Are you working with the same provider who gave you your first cesarean? Was that cesarean truly necessary , was it a cause of interventions pushed on you (induction, MROM, Pitocin etc)?
Some OBs are supportive of vbacs and vbacs can happen with them, but how much of a fight will you have to put up if your OB is not 100% supportive? Keep in mind that their medical training is that they are surgeons, so that will be their predominant mind set – birth always needs help. If you wish to start labor on your own, have a strong relationship with your care provider, be given ample time to labor at your own normal pace, perhaps an out of hospital midwife is more appropriate for you. There are many women who have vbacs in an out of hospital setting (birth center or home birth), find a support group of those women and I’m sure they would love to answer any questions you have.
If you want to be able to walk into the OR room, or you feel safer in the hospital then an OB is for you. There are normal fears and there are fears that can be put to rest with evidence based research. Write down your fears and research them one at a time, this will give you peace of mind for what ever choice you make be that its RCS, home vbac, birth center vbac or hospital vbac. Some women do choose to have a RCS, my intent is to see the women who do NOT choose one and do not want one, know their options and rights and to not be pushed into a RCS. The emotional wellbeing of mothers does matter!
A vbacfacts.com workshop is coming to the Shenandoah Valley hosted at our very own Shenandoah University enxt year, Feb 28,2015. Click this link to find the facebook page with more information.