6 posts tagged “vbac”

You know, I've been posting all this stuff about statistics and studies and research, and I just realized: none of this is for me. All of this information is really for other people, people who don't yet know that I want a home birth or who don't take me seriously.

So, I'll only be posting studies and statistics that mean something to me. I'm no longer collecting data so that I can "prove" my decision to other people. The point is: I'm comfortable with the risks of VBAC; I'm comfortable with the risks of home birth; I'm comfortable with the risks of having a VBAC home birth. I am not comfortable with the risks of birthing in a hospital.

I will VBAC at home, and no study or statistics will change my mind.

Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks of Gestation (Obstetrics and Gynecology, 2005;106:700-706)

Summary: Women attempting VBAC before or at 40 weeks gestation had higher success rates (77.8%) than women past 40 weeks gestation (68.7%). Uterine rupture rates between the two groups were similar. So, VBAC after EDD (estimated due date) is just as safe as before or at EDD, though odds of success are lower.

I can't access the full text, just the abstract, so I'm wondering why the success rates differ between "at term" women and "post-dates" women. My guess is that it has nothing to do with the length of gestation but rather with how a woman's labor and delivery is managed differently once she reaches 40 weeks. Just a guess.

VBAC Facts recently posted a written dialogue between a mom in Southern California and an OB acting as spokesman for a hospital that recently "banned" VBACs. Mom's letter is here and the OB/hospital response is here. Make sure to read the blogger's comments after the hospital letter.

If this is representative of the kinds of lies and twisted truths perpetuated by obstetricians and hospitals unsupportive of VBACs, it's no wonder the C-section rate is on the rise and VBACs are dwindling.

Contrast this study with the one below.

In short, mothers with multiple VBACs have increasingly lower levels of complications while mothers with multiple elective Cesareans with no labor have increasingly higher levels of complications.

Obstetrics & Gynecology (2006;107:1226-1232)

OBJECTIVE: To estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries.

METHODS: Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999–2002).

RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.

CONCLUSION: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.

Straight from the horse's mouth!

Obstetrics & Gynecology (February 2008;111:285-291).

OBJECTIVE: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.

METHODS: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.

RESULTS: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.

CONCLUSION: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.

I feel it important to note that this study does not say that VBACs are always safer than C-sections. It simply reports that once a woman has had a successful VBAC, the likelihood of she having future successful VBACs increases.

For shame, ACOG. For shame.

The American College of Obstetricians and Gynecologists' Statement on Home Births

I find their statement offensive in many ways. I'll briefly address two points, then let you read more from the links below. First, their opinion is just plain insulting to midwives. They imply that monitoring of the mother and baby do not occur at home births (not true), and then state that the only midwives who have any business delivering babies are CNMs. Direct-entry and other "lay" midwives are simply slapped in the face and called unqualified to attend births. All the CNMs I know don't believe this about their non-CNM counterparts.

Second, they insult women by implying that they are not capable to make an intelligent decision regarding the birth of their baby. ACOG says it respects a woman's right to make her own decision, but then tells women that deciding on a homebirth could kill her baby. Frankly, I'm more scared of giving birth in a hospital than I am at home. Hospitals with obstetric surgeons are fantastic for emegencies, but are by no means necessary for the majority of births. ACOG also insults women by stating that the rising C-section rate is due to the increase in old, fat women becoming pregnant. While maternal age, obesity and diabetes are important factors to consider, I argue that a greater cause for the rising rate of C-sections are doctors who continually insist on inducing, augmenting and interfering with a woman's labor process.

I could write an entire book replying to this, but so many eloquent women have already responded. I'll list a few below.

Mommy Blawg responds to several points, and ends her post with a challenge to ACOG.

True Birth analyzes ACOG's statements, then disproves many of them with ACOG's own papers, statistical facts and just plain common sense.

The True Face of Birth responds with what could be her own position paper. Good points here! She also provides an extensive list of other responses to ACOG's statement.

Pushed Birth pushes back and shames ACOG for playing dirty, and attempting to manipulate mothers while discrediting midwifery in general.

ICAN (International Cesarean Awareness Network) responds, encouraging women to make their own informed decision based on facts and evidence-based research.

While I agree with all these women's statements on home births, VBACs and natural childbirth, I do not necessarily agree with everything else posted on their blogs. You've been warned.