I have read Mothering threads for 6 years in which time I have had 4 pregnancies including one c-section birth, 2 VBAC births and a miscarriage. In all this time I have never posted a thread or comment to a thread. I suppose you could say I have always been a lurker. I want to post now in case there are other women in the El Paso or Las Cruces area looking for a VBAC supportive Dr. and hospital. I had a very successful and positive VBAC experience this March at University Medical Center in El Paso. My prenatal care was provided by Dr. Heidi Lyn, faculty at Texas Tech. She happened to be out of town the week of my birth, so my baby was "caught" by a resident Dr. from the medical school. Although each Dr. has his or her own personality, the hospital as a whole is very familiar with VBACs. I made my priorities clear in my birth preferences and the staff was supportive, most especially my nurse. I also hired an excellent doula, Erika Garcia. She is certified by DONA, a Lamaze childbirth educator and lactation consultant. Someone had previously posted on Mothering about Dr. Lyn and UMC which is what led me to birth there. I was so appreciative of the suggestion and tip, I wanted to post my own experience. Please don't hesitate to contact me if you want more information about my experience. I am very happy to share.
VBAC in El Paso, TX and Las Cruces, NM area
Hi My name is Dr. Julio Novoa.
I agree that UMC is the one of the leading centers for the promotion of VBAC and VBA2C. I am a strong supporter of VBAC and perform between 30-50 per year. Since I am in private practice, this is not always easy since the OB is required to be present for the entire labor which could last between 12-18 hours in most cases.
If I am not able to assist in a VBAC, I refer patients to UMC because I feel that the physicians there will take their time and follow the ACOG guidelines regarding the VBAC.
I would also let the women of El Paso to spread the word that VBAC deliveries are offered in both the private and the university setting.
Unfortunately, as a specialist in VBACs, I have seen too many patients come to me for consultations with the complaint that they were told by their OBs that no one in El Paso does VBACs. This is simply NOT TRUE. VBACs are available and are ENCOURAGED by the Centers for Disease Control (CDC), the World Health Organization (WHO), Healthy People 2020, and the American Congress of Obstetrics and Gynecology (ACOG).
So ladies, if you have had a previous C/S and would like to attempt a vaginal delivery with your next baby, please carefully research your choices and remember that El Paso is a VBAC friendly city. :)
I am 10 weeks 4 days pregnant with my second. I am very interested on experiencing a VBAC but am not sure what my chances are.
Six years ago, I had a c-section with my daughter because she was facing up insted of down and Dr. Duarte in Las Cruces did not want to risk turning her as he could not tell if the umbilical cord was around her neck. I was in labor for approximately 26 hours but did end up fully dilated with no sign of the baby being in stress nor I. The only fact that I can honestly say I disliked during my labor was that since I was in labor for so long, every doctor that came in, at different shifts, would examine me. I recall being examined by at least 5 different doctors. It was not a pleasant experience :/
@ marthamydear: I am interested on hearing more about your experience with Texas Tech.
@ jnovoamd: Is UMC the only hospital that practices VBACs? As I would be coming from very west El Paso county area (Anthony,
TX) and the drive concerns me. Which takes me to the reason of why I am debating on switching over to your care
(if possible) your office being in the far east side. I guess I have to balance my pro's and con's...
I am stressing out on this and I know I shouldn't. Please, I ask for your opinion marthamydear & jnovoamd.
Thank you much in advance.
This is Dr. Novoa.
To answer your question, VBACs are allowed at Del Sol, Las Palmas, Providence, and Sierra. I am not sure if the new Sierra Providence Hospital allows VBACs.
Del Sol and Las Palmas allow for VBA2C which means they allow for VBACs when a patient has had a previous C/S twice. UMC allows for VBAC and VBA2C.
The reason UMC is recommended is that because it has a residency program, doctors are available 24/7 to perform VBACs. They also state that their VBAC success rate is 85%.
I specialize in the VBAC and have privileges at Del Sol, Las Palmas, Providence and Sierra. However, due to the logistics of doing a VBAC, I really only do them at Providence and Sierra Hospitals.
My success rate is 90%. You can check out my stats for the past 3 years on my website at www.firstchoicemedicine.com.
The national average for VBAC success is between 60-74%, which is still very good.
We are launching a VBAC site next week. The domain names will be vbacelpaso.com and elpasovbac.com. They will be able to provide more information for you.
However, please remember the following: The National Institutes of Health (NIH), the Centers for Disease Control (CDC), the Department of Health and Human Services and the American Congress of Obstetrics and Gynecology (ACOG) are all now recommending that doctors offer the VBAC as an alternative to repeat C/S.
The risks associated with the VBAC in comparison to all combined reasons why we are doing C/S are actually lower than repeating C/S.
The risk of uterine rupture is 0.47-1% and if a rupture exists, the risk of death to the mother is extremely low (almost 0%). However, the risk of death of the baby from a uterine rupture is listed at 3-6%. HOWEVER, despite what is commonly stated by OBs, the combination of uterine rupture plus maternal or fetal death is very low and this is why NIH, CDC, and the ACOG are all in support of the VBAC.
Finally, a hospital can NEITHER prevent you from having a VBAC or MAKE YOU HAVE a C/S for any reason. The decision is yours so you need to be aware and prepared. If you feel pressured to have a repeat C/S once you get to the hospital, especially if you are being told that the baby is in some type of distress, get it in writing BEFORE you have the C/S and if possible, have two doctors sign off.
If your doctor does not do VBACs or the on-call doctor does not do VBACs, this is not enough of a reason to make you have a repeat C/S. It is the hospital's responsibility to provide adequate care and coverage for either a VBAC or Repeat C/S scenerio.
FYI, about 1 and 3 babies are born with their cord's around their neck. This is common and is not considered to be unusual or an emergency situation. And it is not a reason to do a C/S.
When I do perform VBACs. I wait for a patient to go into natural labor. If an induction is attempted, the failure rate can be as high as 50% (which all patients wanting to deliver on a particular day should be made aware of; they have up to a 50% risk of ending up with a C/S from an induction). Although 20 hours is average for an induction, 26 hours is not unusual.
I tell my patients to wait for natural labor and most VBACs will deliver within 12 hours of their arrival time to the hospital.
Also, a face up presentation, or occiput posterior (OP), is not an indication to do a C/S. Most babies are born face down, occiput anterior (OA), but OP is still ok, although it takes a little longer to deliver. I am sure that your doctor had another reason to recommend C/S. Now if I am confusing face up with BREECH presentation, then YES, BREECH presentation is an indication to do a C/S.
If one of my babies is born OP, this is fine and does not need to have its body turned or be absolutely sure where the cord is, since, again, a high number of babies are born with the cord around their neck.
Thank you so much for your replies Dr. Novoa. They are very helpful & hopeful. I find this situation quite stressful and almost feel forced to have a c-section again.
Monthly visits with you are only available at your east side office?
Either way, I foresee getting in contact with your office soon.
I'm sorry my reply has taken a while... it seems my 3 children keep me extremely busy these days! I am not a Dr., just a patient, but I agree completely with everything Dr. Novoa wrote! I have had a vbac in College Station, Texas and in El Paso and I think the MOST important thing is to find a supportive care provider. I am happy to share more about my experience at University Medical Center. I know how very stressful it is as you prepare for birth. Would it be possible to private message you?
Congratulations on your pregnancy!
Yes please, I would greatly appreciate it.
I'm just not sure if there's anything special
I've got to do on my side to accept
Edited by nango - 8/30/12 at 11:35am
I can't seem to private message you. I've never had trouble with this before. Maybe you can try to private message me and I can see if I could reply? Please let me know if you have specific questions about my experience.
As I mentioned, my VBAC in El Paso was my fourth pregnancy. I had a c-section, then a vbac, my third pregnancy ended in a miscarriage. Dr. Lyn helped me through my miscarriage a year and half ago. After her kind and supportive demeanor through the miscarriage, I knew I could really trust her. Fortunately, I got pregnant quickly after the miscarriage. Our baby was born at UMC about one month after the new building opened. The facility is very new and clean. Because the hospital can prep for c-sections quickly, I think almost all (if not all) of the doctors support vbac. Of course, each has their own preference about monitoring, position, etc. I did have two different residents assess me when I arrived and may have seen more Drs if I had been there longer in labor. Dr. Lyn was actually out of town that day. There is very much a "teaching" feel to the hospital. Fortunately, the end of my birth went very quickly. The nurse I had was AMAZING. She completely respected my desire for natural birth. I also hired a very good doula, Erika Garcia. She is Lamaze trained. My husband is a wonderful birth partner, but even he agrees it is nice to have a woman by my side at the end.
Ok. That's a little summary. Like I said, try to private message me and I would be happy to share anything else you are interested in. Hope you and your baby are doing well!
Thank you so much for the information.
I have been reading on doula's and been wondering if they are worth the time and of course the money.
According to many reviews, sounds like they are.
I have a coming consultation regarding a possible VBAC
Wish me luck :)
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I just wanted to chime in and let you know that there is a wonderful group of CNM's that also deliver vbac's at UMC. I've heard amazing things about Betsy Portugal, who is one of the CNM's at Texas Tech. And Erika Garcia is a great doula and very knowledgable about the hospitals, their policy's, and a lot of the OB's.
Yes, although I don't deliver at UMC, it has a very supportive environment for VBAC. I recommend UMC to all of my VBAC patients if I am not able to assist with the VBAC.
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I wanted to do a vbac with my 2nd (the first was horrible experiance with a horrible dr) but i absolutely loved the dr i had for my second child and she did not do vbac's :( So i went ahead and did another csection. I'm now on my 3rd and was wondering if the Texas Tech midwives or any local healthcare provider would do a vbac after 2 previous csections. I've heard great things about Ms. Portugal as well but I haven't heard anything about whether they would attempt it after 2. :(
Yes, I have heard very good things about Betsy Portugal. I am not sure if she would work with a VBA2C. You may consider setting up a consultation with her to discuss it. Perhaps if she does not do VBA2C she can tell you if someone else does. You may also consider contacting Maternidad la Luz, the local birth center. I am not sure if they work with VBA2C, but again, they may have a suggestion for someone who does. Best wishes, lindy23, for a happy and healthy birth.
Del Sol Medical Center, Las Palmas Medical Center, and University Medical Center allow for VBA2C. I have one of the few doctors in private practice offering VBA2C, which means VBAC after 2 previous C/S.
Contrary to what is commonly stated, both VBAC and VBA2C pose low risks as compared to Repeat C/S and should be offered as options but fewer than 5% of private practice OBs offer these services.
Dr. Julio Cesar Novoa, M.D.
In regards to birthing centers and VBAC:
Birthing centers are not equipped to handle emergency deliveries, especially in case of uterine rupture associated with either VBAC or VBA2C. The risk of uterine rupture is less than 1% with a previous C/S x1 and 2% with previous C/S x2. If a uterine rupture were to occur, the risk of death to the mother is very low, approaching almost 0%. HOWEVER, the risk of death to the baby is between 3-6%, with risk of permanent damage much higher.
If a uterine rupture were to occur at a birthing center, it could take up to 30 minutes for a patient to arrive to the ER of the nearest hospital and up to an additional 30 minutes for the OB on-call to the hospital to arrive for an emergency deliver of the baby. Few birthing centers have contract agreements with private OBs in El Paso; therefore, if an emergency requires transfer to the nearest hospital, it is highly probable that the OB "on-call" will not be in the hospital and will not be called until the patient is evaluated on Labor and Delivery.
Brain damage and/or death can occur within 5 minutes of a uterine rupture. Therefore, permanent injury or even death of the baby could occur even before the arrival of an emergency response ambulance transfer team.
This is why I recommend that you make arrangements with any OB willing to assist you with a VBA2C at either Del Sol, Las Palmas or University Medical Center. However, the UMC midwives are excellent and will have an OB back-up in house at all times should you want to go to UMC.
Dr. Julio Cesar Novoa, M.D.