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Thursday, March 11, 2010

Headed in a Better Direction?

If you are at all involved in the birth world or consider yourself somewhat of a VBACtivist I'm sure you've heard of the National Institutes of Health consensus conference where they discussed VBACs in light of the decline of VBACs in the last 15 years and the increasing cesarean rate. I won't get into the whole conference on this post - because there is SO much to blog about in regards to that. But I must say that my following of this has almost led to a renewed explosion and passion in my heart for better birth in America.

What I really want to talk about is this particular article that stems as a result of the conference: Base VBAC Decision on Evidence NIH Panel urges. That title just gives me chills. There were many OBs, midwives, PhDs, etc in attendance at this conference. Along with some birth activists just like you or me. This article sums up the conference for you. There are six questions that the conference was asked to look at and answer after conference discussion. The first link I posted has all of the questions and the long answers. It also provides many statistics and evidence to support the answers.

Not only from these articles, but from the bits and pieces I've picked up from Facebook, twitter, etc - it is my impression that the conference was very positive in that VBAC is seen as a vital option and that true informed consent should be given to women (not just a speech about all of the dangers of VBACing and uterine rupture and no mention of the RCS risks). However, I am cautiously optimistic, as it is one thing to urge providers to use evidence when helping women choose VBAC or RCS, it is another thing for providers to put it into practice. But, hey - one step at a time, right?

One item that really sticks out was this mention by ACOG's president:

"The report in general is very good," ACOG president Gerald F. Joseph, Jr., MD, said during public discussion of the draft report. His only suggestion was to strengthen the report's comments on liability issues.

It was found that liability is a prime reason that some OBs won't support VBAC, or are quick to abandon the VBAC attempt. If that is where the true inhibition lies for OBs, we must make a difference somewhere in order to take that liability away from OBs. If that's what we need to do to give women a fair chance, we need to fix that, however, that in itself is a whole other discussion.

I hope with all of my heart that this conference is the start of an upswing in our country. So that women actually have a CHOICE in how they birth and that they are presented with true informed consent of the risks on both VBAC and Repeat C-sections.

To read ICAN's official statement on the VBAC statement, click here.

Saturday, March 6, 2010

Why Is VBAC a Vital Option?

Why is VBAC a vital option? by Heather Deatrick and Jess B.

*This post is the combined thoughts of Heather, ICAN Twin Cities member; and myself, Jess, ICAN Twin Cities member. Written for the ICAN Blog Carnival and for all birthing women out there.

Jess: How do we even start this post? Why is VBAC a vital option – I have reams and reams of information in my head – and I know that there is evidence upon evidence to support why I think and know that VBAC is a vital option. I am a perfectionist and like to wait until things are perfect before I submit them. But, in order for me to meet the deadline for this post – I am afraid that I will not be addressing every issue – besides the fact that I think this would turn into a doctoral thesis if I did!

Heather: To me it is obvious. The c-section rate is climbing. The rate it is going, followed by subsequent c-sections, means women are facing surgical birth as the norm. This defies logic as women have been giving birth for thousands and thousands of years and we have been a very successful species. The most successful actually, and hand washing to prevent disease only started in the last 100 years! To suddenly, in a matter of two decades, have birth become something that women cannot do without the help of a surgeon is arrogant and dangerous.

Jess: Let me start by stating that I had a successful VBAC in 2009. My c-section was in  2006 after an induction for pre-eclampsia at 36w5d. A nurse talked me into an epidural at 3cm (easy to do when the mom is in a fog due to Magnesium Sulfate running through her veins) even though I wasn’t feeling any pain. Shortly thereafter, my bp dropped significantly and my son responded by giving a bunch of whopping late heart decelerations. Hence my “emergency c-section” under general anesthesia. I knew before I even left the hospital that my next birth was going to be a VBAC. I even had nurses telling me, without me even mentioning my desire to VBAC, that I will never be able to have a vaginal birth as there would be too much risk for me and the baby. I must admit that my initial decision to VBAC was highly emotionally driven. I mourned the lack of initial bonding with my baby and the fact that he was given bottles by the nurses right away, thus ruining our breastfeeding relationship. But, hey, in no particular order of one reason being the best or that type of thing, there is reason number one why VBAC is a vital option – for the emotional health of the mother. Honestly – I’m tired of people who brush aside the emotional importance or significance of a vaginal birth – these factors are also important – so let’s start supporting mothers in that quest.

Heather: We know that while childbirth certainly has been dangerous in the past, this did really change with the advent of washing hands, and the ability to stop hemorrhages. Though while it was dangerous, it certainly wasn’t 30%, the way the c-section rate is now. I think it is abundantly clear that the rising c-section rate has to do with other things-technology, fears of litigation, time constraints for the doctors.

So why is VBAC vital? With every c-section comes a woman’s higher chance of death, comes a babies higher chance of breathing problems and asthma and who knows what else. We know that nature does everything for a reason, and vaginal birth is no different. The only way we are going to stop the runaway rising c-section rate is to start making VBAC the norm. When that happens, the provider will start to view vaginal birth as the norm again. It seems to me that vaginal birth is viewed as abnormal and a woman is “lucky” these days to have one.

Jess: I want to point out what some of our resources show. The Mayo Clinic states that the cons to C-section are: Your hospital stay will probably be longer than if you'd had a VBAC, Pain and fatigue linger longer after a C-section, you may wait longer to bond with your baby and begin breast-feeding , A repeat C-section makes it riskier to attempt VBAC for your next baby. C-section poses rare — but real — risks to your baby, such as premature birth and breathing problems. The risk of needing a hysterectomy to stop bleeding after delivery increases with the number of repeat C-sections. A C-section costs more than a successful VBAC does.

I once heard the quote “A C-section is a controlled rupture of the uterus.” I’ve had so many people throw uterine rupture in my face during my VBAC pursuit, a real risk no-doubt, but maybe I should have countered with the controlled rupture line.

Generally, if you have a low-transverse scar on your uterus, your risk of rupture is less than 1%. This article helps put VBAC and uterine rupture in perspective.

Heather: I have a feminist slant too as to why VBAC is vital. To me it seems that this a way to take away the controls from women that used to be 100% ours. Once, women gave birth out of our vaginas and women, midwives, throughout cultures and throughout time, caught them. This was one part of a woman’s life that was sacred and males were not a big part of, but certainly were in awe of. After all, to have a baby is almost god-like—to create and birth life is incredible. My own father told me when I was girl how lucky I was, and what an honor it was. While it is wonderful to have men part of this now, I would never change that, it is no longer a woman who does it. It is a monitor, a fetal scope, a suction, an epidural to sleep, a scalpel, a doctor delivering. It is our body totally controlled by an institution the minute we walk into a hospital. It is the ultimate handing over of our body to another.

To me, a c-section should really be only life saving. A woman today should be able to really say “thank goodness for modern technology that saved my baby and me.” While maybe a lot of women ARE saying that (even I did!), it isn’t the truth and really, modern technology has actually killed many. In this day and age there is no excuse or valid reason for a rising maternal mortality rate. I truly believe that changing the tide on VBACs is the answer.