Hi everyone. I don't post much because Sarah does such a wonderful job, but I came across this article and it illustrates so clearly what women wanting a VBAC are up against:
Hart to Heart: Opinions vary on c-sections
Anne Hart Sunday, February 1, 2009 at 12:30 am
Cesarean sections require more time to heal than vaginal births. They're almost twice as expensive. And multiple c-sections bring risk of complications. Despite those disadvantages, c-sections are now more popular than ever. C-sections accounted for 43 percent of the births last year at Candler Hospital and 37.6 percent at Memorial University Medical Center. They're also on the rise nationally, with some hospitals reporting as high as one in two births as cesarean, according to the International Cesarean Awareness Network, which educates women about the risk and dangers of c-sections.
While c-sections are sometimes medically necessary, factors such as the increase in doctors who've stopped performing vaginal births after a c-section (also known as VBAC) are driving up the rate. Candler only had eight VBACs attempted last year out of 3,191 deliveries. Seven were successful. In 2007, the hospital had one attempted and successful VBAC out of 3,040 deliveries.
Instead of VBACs, women undergo elective repeat c-sections, which now represent about 40 percent of the 1.3 million cesareans performed each year nationally. Are c-sections, which are major surgical procedures, being over-performed? Like most medical questions, the answer depends on whom you ask.
VBACs vs. repeat c-sections
A new study in the New England Journal of Medicine found early, elective, repeat c-sections can lead to an increased rate of complications, including infections. According to researchers, more than a third of elective repeat c-sections are performed too early. The American College of Obstetricians and Gynecologists recommends that elective c-sections be performed no sooner than 39 full weeks of gestation, unless there's a medical indication. The study found that 36 percent were earlier. Both Memorial and Candler follow the ACOG recommendation - when and if VBACs are done at all.
VBACs were briefly popular a few years ago, increasing from 3 percent to 28 percent from 1981 and 1996, but now the trend is going the other way. Doctors don't want to take on the medical and legal liabilities linked with VBACs, experts say. A vaginal delivery after c-section carries a one in 200 chance of uterine rupture.
Dr. Glen Scarbrough, chair of the department of obstetrics and gynecology at St. Joseph's/Candler Hospital, doesn't outright ban VBACS among his patients, but he does discourage them. He says the VBAC success rate is low and not worth all the risks involved. He attributes the VBAC decrease to concern for safety. Scarbrough doesn't see the overall c-section trend as necessarily negative. After all, today women undergo emergency c-sections when labors fail to progress. But decades ago, women used to be allowed to labor for hours upon hours, then forceps were used. "I'm not sure we want to go back to that," Scarbrough said. "Now it's a lot less traumatic for moms as well as babies."
However, Dr. William E. Osborne of Provident OB/GYN Associates supports VBACs when appropriate. "It's a safe procedure, but it just has a risk that some people are unwilling to take," Osborne said. Physicians are required to remain in the hospital throughout the entire labor while a mom attempts a VBAC, rather than just be there through the active labor phase. Osborne is concerned about the move toward c-sections overall and the trend of early labor inductions, especially those being done for the sake of convenience.
There are ways for women to decrease their chances of a c-section. Starting with finding a doctor with a low primary c-section rate. But with medical risks, personal concerns and legal liabilities looming over physicians and hospitals, a mom has no guarantee when it comes to avoiding a c-section. In the end, the outcome is what counts. The goal is for a healthy baby and mom.
No matter how the birth happens.
I am so appalled by Dr. Scarbrough's comments (in bold) and attitude towards VBACs and c-sections that I really don't know what to say, except to warn women that this is the kind of rhetoric doctors use to force us into repeat c-sections, or primary c-sections. He sees nothing wrong with it, yet the evidence contradicts this. Just about everything he says is wrong -- VBAC success rate low--at 70%? VBAC not worth the risks involved...for who? Women "allowed" to labor for hours and hours..isnt that normal and necessary for many of us? C-sections less traumatic for women and babies...who says? -- and makes clear, again, what an uphill battle we have to help make VBAC available to all women. This is a reminder to all seeking a VBAC--be sure to ask your doctor or midwife their views on VBACs. Any comments such has Dr. Scarbrough's should be a major red flag!