VBAC: First, Do No Harm

I just spent the first part of this week at the National Institutes of Health VBAC Conference in Bethesda, Maryland.  If you you’ve read a newspaper or listened to NPR in the past couple of days you may have read about the conference panel’s major finding: that the medical evidence suggests most mothers who have had a cesarean should be able to safely deliver their next baby vaginally. This is BIG news because, as most mothers who have had a c-section know, currently less than 10% of mothers in the United States are having VBACs (a severe decline from nearly 30% in the mid 1990s). And if the reasons mothers are being denied or encouraged not to do a VBAC are not medical, then what’s up?

I put this “what’s up?” question to the test with my two home birth boys, ages nine and ten at the dinner table after the first day of the VBAC conference proceedings. I told them of an obstetrican named Dr. Stuart Fischbein, well known and beloved by VBACtivists, who got up and told the NIH panel that if  the old adage “once a cesarean, always a cesarean” is now clearly not supported by evidenced-based science then the innumerable hospitals who deny VBAC and doctors who will not support women to have VBACs are violating the doctor code of ethics, “First, do no harm.”

Jacob was the first to jump in. “You mean after they cut a mother open for one they are cutting her open again? That’s really scary.”

Aden: “Will the moms die?”

No, most will not, but they can have alot of medical complications for life, especially when you have more than one cesarean.

Jacob: ” Like what?”

Massive hemorrhage, bloodtransfusions, injury to bowels.

The boys simultaneously gasp.

Jacob: “Why are moms even using doctors? Just go to the midwives.”

Aden: “Yeah, midwives would never do that.”

It was pointed out that women who VBAC most successfully are usually in the care of midwives and family practice doctors, although there is no strong scientific evidence to support this.

Aden: “Why don’t doctors help moms not be cut?”

You see, there are these guidelines from the American College of Obstetricians and Gynecologists (ACOG) that say a hospital must have emergency services “immediately available” in case an attempted VBAC has problems and many hospitals say they cannot meet that standard.

Jacob: “What kind of complications?”

The mom’s uterus could rupture and she and the baby may die or be injured.

Another gasp.

Aden: “How many moms does this happen to?”

Less than 1 percent. Not a very high chance.

Jacob: “Wait. Let me get this straight. They are HARMING moms because practically nothing will happen?”

You could say that.

Aden: “That’s wrong!”

Jacob: “Totally whack.”

It’s a human rights abuse, really.

Aden: “What’s a human rights abuse?”

It’s when someone is being harmed for no good reason.

Jacob: “Oh yeah, this is a human rights abuse big time!”

Aden: “I feel sorry for moms.”

Me too.

Jacob: “Can I come to the conference tomorrow and tell them about midwives and home birth?”

This is a scientific evidence-based conference. Your story really won’t matter to them.

Jacob: “I’m evidence! Evidence that midwives rock!”

Aden: “Mom, please tell the moms at the conference that we know their bodies rock, even if the doctors don’t.”

I will give them that message.


PS: as you can imagine with my play’s popular mantra “My Body Rocks!” my boys have it ingrained into their minds that pregnant moms bodies rock!

PS: In general, VBACtivists were pleased with the NIH panel’s statement because it addressed, among other things, ACOG’s ridiculous “immediately available” guideline and urged them to change it. But there are so many factors affecting access to VBAC that only time will tell if we start seeing a surge in VBACs!

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3 thoughts on “VBAC: First, Do No Harm”

  1. Hi Karen,

    Thank you for your play Birth. I went to see it in NYC with my husband when I was 3 months pregnant with my now 2 year old son. I knew I wanted an unmedicated no-low intervention birth but I also knew that to make that happen I needed to get my husband on board and educated about the realities of birthing in a hospital. I found out about your play from Dr. Northrup’s newsletter and thought that seeing it with my husband would be a good starting point for our birthing discussions. I was right! The play was fantastic and it gave my husband a perspective about birth that he did not have before. We were treated to a panel discussion of birthing experts after the play and I found even more resources to help me on my journey towards natural birth in a hospital.

    I had a natural water birth in a hospital with a midwife and a doula present. My husband was in the tub with me. I had a 9 hour start to finish labor and mostly labored at home (I got to the hospital and was fully dialated). I know that my positive birthing experience was possible because of my birth preparation work. Seeing your play definitley empowered me to give birth the way I wanted to give birth. I am dreaming of a home birth for my next child.

    Thank you!


  2. Hi Katie,

    I’m honored to know my play helped empower you to give birth the way you wanted to. That’s my hope for all mothers.

    Keep up the “My Body Rocks” spirit…and can’t wait to hear about your next home birth!

    BOLDness to you,

    PS: It looks like there may be a production of the play in Harlem this year, around Labor Day. If so I will most likely speak after a performance for teenagers and also a general audience performance. Check the website in the next few months for details. I hope to meet you!

  3. Loved your post. I was one of the many that had an unplanned and completely unnecessary c-section with my first. I was 23 and in perfect health. My doctor induced me when I wasn’t ready and gave me a c-section after 12 hours of labor. I was so angry after this birth that I knew I had to go the homebirth route to avoid doctors. It really is something to not feel safe around people who are supposed to be helping you. With my second I went 12 days past my “due date” and was in labor for 25 hours and had a completely healthy (APGAR 10) baby boy in my living room.

    So many mothers out there aren’t even given a choice to VBAC. They have no idea how harsh it can be on your body and your future of having more children.

    Thank you for your post. I love how the children make it sound as medieval as it is.

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