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A few concerns I have - Page 2

post #21 of 48
Quote:
Originally Posted by Viola P View Post

The woman I know who's uterus ruptured said she knew it happened immediately because the pain was a totally different kind of pain and it was way more intense

6% (neonatal death) of 4% (high end muliple c section hbac) is 0.24%.


I'm glad she was able to get treatment promptly. The fact remains that many women who experience this complication don't immediately recognize that it has occurred. The most reliable indicator is fetal heart monitoring.

Re: the math. Yes, it's a relatively small absolute risk: 24/1000.

If someone is choosing to UC for any range of reasons (religion, past trauma, etc.) then they may very well decide that the benefits of staying home outweigh the risks. If someone is choosing to UC because they believe that it's as safe or safer than the hospital, then they should understand that this isn't the case when it comes to VBACs.

The neonatal mortality rate in the USA is about 4/1000 , which includes preemies, who represent most deaths.

I sure as heck would want to know that I was accepting a mortality rate six times that high for a full term baby.

Heck, that's almost twice the rate in the West Bank and Gaza Strip for all babies, including preemies.

In any case, you also have to take into account morbidity rates for both mother and child. Uterine ruptures are associated with a massively increased risk of brain damage for babies and hysterectomies for mothers. These occur more frequently than deaths.

This is one of those complications that is really a big, big deal. I'm very, very happy that your friend and her child were alright. I certainly believe in your right to make your own decisions based on your beliefs and experience, but telling people that uterine rupture is no big deal if you're near the hospital is dangerous.

(I love the hotel advice! Just open up the minibar and turn on the tub smile.gif )


Edit: One more way to visualize a number like 24/1000:

Yankee Stadium seats 50,000 fans. If 1200 fans were dying every game, would you consider that a safe place to go? Would you send your family there?
post #22 of 48
I wasn't advocating it simply trying to be supportive and not bang her over the head with the fear hammer.

When it comes to childbirth there is no example where a stadium with that many people would all be okay.

OP it's totally up to you. Yes there's an elevated risk of serious problems, but it's up to you to decide whether you're okay with that. There are also risks of multiple c-sections including increased mortality and hysterectomy, to name just a few of the nastier ones.

There are no risk free options when it comes to childbirth.
post #23 of 48
Fear mongering again...anybody else think appalled is bonetopick???? :-)
post #24 of 48
Maria, if you feel lead to uc and comfortable with it, go for it.
post #25 of 48
"Anyone else think appalled is bone..."
Hahahaha
post #26 of 48
Quote:
Originally Posted by Viola P View Post

I wasn't advocating it simply trying to be supportive and not bang her over the head with the fear hammer.

When it comes to childbirth there is no example where a stadium with that many people would all be okay.

OP it's totally up to you. Yes there's an elevated risk of serious problems, but it's up to you to decide whether you're okay with that. There are also risks of multiple c-sections including increased mortality and hysterectomy, to name just a few of the nastier ones.

There are no risk free options when it comes to childbirth.

I'm trying to provide her accurate information to make that decision. You're saying things that are flat out wrong.

Maybe she shares your view of things. Maybe she's also incapable of understanding the difference between a very low number and a much higher number. Maybe she also thinks thinks that "risk" means the exact same thing whether it's 1 in a hundred or one in a thousand or one in a million. Maybe she's also stuck in this 1952 mentality where women can't be expected to wrack their pretty little brains over all these darn numbers and math.

But maybe she doesn't. Maybe she came here to get accurate information to make an informed choice.

I completely understand why you would choose to UBAC. You had a traumatic experience and that's part of your personal calculation. I get it, and I support your right to make that decision 100%. But she's not you. Doesn't she deserve accurate information so that she can make the best choice for HER?
post #27 of 48
Yes! What did I say that was flat out wrong?
post #28 of 48
" It's my understanding that uterine rupture is very rare but that when it does happen you'll probably be fine if you're close to the hospital."

This.
post #29 of 48
Is that an exhaustive list?

Why did you say the rate for multiple c-section is "up to" 3-4%? Does that mean it's lower in other studies? To me that percentage is still relatively small. According to the stats you use the rate of catastrophic injury is 0.24% - which to me does mean that such injury is very rare.

Regarding proximity to hospital, you yourself imply that this matters. Are you saying it doesn't? I couldn't imagine you taking that position.

There are serious risks and I think that we both agree its up to OP to weigh these and make her own decision. There are risks to another c-section as well, going to the hospital doesn't make birth risk free.
post #30 of 48
Quote:
Originally Posted by Viola P View Post

Is that an exhaustive list?

Why did you say the rate for multiple c-section is "up to" 3-4%? Does that mean it's lower in other studies? To me that percentage is still relatively small. According to the stats you use the rate of catastrophic injury is 0.24% - which to me does mean that such injury is very rare.

All true. There aren't too many studies on VBAMC (and none on UBAMC). Those studies that exist show a rate of rupture between one and 3.7 percent. For the sake of argument, let's cut that risk down 6/1,000 instead of 24/1,000

You're also correct to say that the risk is relatively small. My point is that despite the relatively low absolute risk, you're entering into an entirely different neighborhood of relative risk than in a normal, uncomplicated birth.

Look at it this way: I see a lot of women who are concerned by the risks of maternal mortality from a c-section. But the rate of maternal death for elective c-section is something like 6 in 100,000.

I don't understand how anyone could be concerned by a risk of 6/100,000 and then turn around and say that 6/1,000 is so small that anyone who so much as mentions it is fearmongering.
Quote:
Originally Posted by Viola P View Post


Regarding proximity to hospital, you yourself imply that this matters. Are you saying it doesn't? I couldn't imagine you taking that position.
There are serious risks and I think that we both agree its up to OP to weigh these and make her own decision. There are risks to another c-section as well, going to the hospital doesn't make birth risk free.

Sorry, I should clarify this point. You're absolutely correct to say that proximity to an OR is essential when it comes to uterine rupture. The only treatment for a rupture is an emergency c-section and we know that the longer it takes to get one, the worse the outcomes are. My objection is that I have a really hard time seeing anyone get from home to the OR within a desirable window unless you literally live across the street. The odds of making it to the hospital before you cross the threshold into the territory where really bad outcomes start to become a real possibility are poor even if you live "only ten minutes away." You're post made it sound-- to me at least-- like its a realistic possibility for most women to realize there is a problem, decide to transfer, struggle out of the house and into a car while in the middle of a complex labor, get to the hospital, and get prepped for surgery in the 10-25 minute window that you're shooting for. I don't think it is.

That's not to say that a 30-40 transfer ALWAYS means a disastrous outcome-- your friend is proof that it doesn't. But she was really, really lucky. That's why even organizations and experts that support both VBAC and homebirth consistently advise against UBAC. That's why all guidelines for trial of labor emphasize the importance of being prepared to perform an emergency c-section within minutes.

I think the more accurate thing to say "The risk of rupture is real but relatively low, but the consequences of a rupture at home are potentially disastrous."

I realize that this wouldn't change your mind-- and I get why that is. It might change someone else's mind, though, so I think it's worth pointing out here. No one is claiming that there is a zero risk option. That doesn't mean that we shouldn't weigh the risks that do exist.


*******This blog post lays out the problem with the whole idea of "ten minutes away:" (http://10centimeters.com/friday-fallacies-the-hospital-is-just-minutes-away/)

"There are plenty of problems with the “The hospital is only minutes away!” platitude...
One is the idea that being “ten minutes” from a hospital means that you can go from realizing there’s a problem to having the baby out and alive in ten minutes. This scenario is certainly realistic. IF YOU’RE ALREADY IN THE HOSPITAL. The hospital where I volunteer as a doula can perform a stat c-section in eight minutes... You will have to get to the ER somehow. If you’ve called EMS, it will probably take them a minimum ten minutes to get to your house, five to ten minutes to grab you, load you in and get the hell out, and another ten minutes to get to the ER. Hopefully the paramedics have called in to let them know what to expect and the OBs are racing to the ER to meet you. If you don’t call an ambulance, it might take less time to get to the hospital (or not, seeing that your laboring body probably isn’t moving too quickly), but you don’t have the call ahead or stabilization the paramedics could provide.

Once you’ve arrived, an entire team flocks to you, hooking up monitors and placing IVs, all while trying to get the appropriate details. ...[If you had been laboring in the hospital, the history and physical notes, progress notes, labs (you’re going to need your blood typed and crossed for surgery), and IV sites WOULD ALREADY BE DONE. If you are dehydrated from laboring for an extended period of time or from an attempt to induce your labor using castor oil, they will have a hard time inserting the IV, which could cost precious minutes. They will use a portable ultrasound to check the baby unless the head (or body, as in the Lucian Kolberstein and Henry Bizzell cases) is out, in which case they will attempt to get the baby out or head straight for the OR. Even the very best and most efficient team is going to take an additional ten minutes after you show up in the ER to have you prepped and in the OR for an emergency cesarean, and that’s with rapid intubation and general anesthesia. The BEST CASE scenario is 30-45 minutes, not the eight it would take if you were already there.

Now, this scenario only applies if you happen to live in an area with a large teaching hospital and on-call OBs 24/7. What happens when the closest hospital is a smaller community hospital? More than likely, the only doctor there is going to be an ER doctor, not an obstetrician. The OB will have to be called in, as an ER doctor isn’t going to perform a cesarean unless you are dead and your baby is still alive, and may live up to 30 minutes away from the hospital. If the ER doctor is able to deliver your baby — which he hasn’t done since med school — he or she may be the only doctor at the hospital, so the focus will be split between you and your child. He or she may not have intubated an neonate since med school, either. He or she may not be required to have a neonatal resuscitation certification. By the time the OB and pediatrician arrive, an hour may have passed since your midwife first realized you were in desperate need of a transfer."
post #31 of 48
Too true. I attempted to skim an article yesterday about the risks in c section themselves but the article was too long. I couldn't finish it. Point being, there's risks at home. There's risks in hospital. C sections carry their own set of risks. So basically, take the c section risks with guaranteed c section or take the home birth risks with much more likely vbac and preferred birth. That's up to OP
To decide. Although I think OP came her for UCers input obviously because that's what she's leaning towards. She didn't come for an anti UCers point of view
post #32 of 48
Quote:
Originally Posted by sgnorton123 View Post

Too true. I attempted to skim an article yesterday about the risks in c section themselves but the article was too long. I couldn't finish it. Point being, there's risks at home. There's risks in hospital. C sections carry their own set of risks. So basically, take the c section risks with guaranteed c section or take the home birth risks with much more likely vbac and preferred birth. That's up to OP
To decide. Although I think OP came her for UCers input obviously because that's what she's leaning towards. She didn't come for an anti UCers point of view

Anti-UCer?  How many times have I said that a woman does and should have every right to UC?  How many times have I acknowledged that for people like Viola the benefits of UCing certainly may outweigh the risks?  

And your inability to read an article doesn't prove any point at all. Of course there are risks in any option. It's risky to ride a bicycle down the sidewalk. It's risky to ride a bicycle on the shoulder of a busy highway at night. Guess which one my kids are allowed to do?
post #33 of 48
Thread Starter 
Well thanks for all that. I'm fully aware of my risks for a vba2c. I've done my research. There is also risks of a repeat c-section as well. On the ican website it said you are 6 times more likely to have a complication from a repeat c-section than a vbac. I understand I wouldn't be at the hospital in the unlikely event of an uterine rupture, but that honestly doesn't put me off from a homebirth. I understand there is a risk that something could go wrong at home, but there are risks that something could go wrong in the hospital. I could've died during my last c-section, but I didn't.
post #34 of 48
Oh, by the way Maria, I don't know if anybody ever really addressed your question about how the hospital would respond if you transferred. I think it really depends on not only the hospital, but the Dr you get. I'm a firm believer that honesty is always best and would tell the truth no matter the scariness or the consequences of it. I had my baby on Christmas eve day. Although all was well with him I went to the ER twice due to nothing being open for the holidays. First I went because I'm rh negative blood and need a special shot in a limited time frame and second I have an umbilical hernia that was aggravated during labor. I actually went in two separate days because I was hoping my hernia would be ok but seemed to get worse. Anyway, the first visit the Dr was somewhat questioning and surprised how I'd birthed. I answered all his questions although much had nothing to do with why I was there. He at least was fairly respectful and I got my shot and left with no problem. Second I got a woman who was awful to me telling me the baby needed to be seen, he needed shots and eye ointment. She asked if I was going to bring him in...ugh, I finally told a lie there. As strongly as I feel against it she had be terrified that I'd have cps on my doorstep so I felt the need to appease her although I had been completely honest up till that point. And when she felt my hernia she
Pushed on it and hurt me and I can't help but wonder how much of the pain inflicted was intentional. I mean this woman was fuming mad! Her face was bright red. She sent somebody else back in the room with a tummy wrap thing and my diagnosis papers. Anyway, baby hasn't been seen. I'm anti vax and the eye ointment...yikes, completely unnecessary. So, I guess do what you gotta. If I have to go in again for anything though I'd still tell the truth again. I just have to. That's just me :-) hopefully if you needed to go in for anything you'll have a more pleasant experience than me
post #35 of 48
@appalled - the worst case scenario you present is awful. Still a risk of .24 is small.

The truth is that there are all kinds of avoidable risks that pregnant women choose to take every day for a variety of reasons including necessity and personal comfort. Each and every time you drive a car there is a risk of fatality. Walking under a coconut tree and swimming in the ocean all carry risks and are all probably easy to avoid. Should we start citing all these risks in order to scare women out leaving their houses? Are pregnant women morally obligated to take the least risky path in every situation? I think the answer to both questions is no.

The increasing restrictions placed on pregnant women in the name of "safety" are highly disturbing and are also, evidently as the maternal mortality rate continues to rise, ineffective.

My body my choice, period.

ETA

http://plato.stanford.edu/entries/ethics-pregnancy/
post #36 of 48
Thread Starter 
We are anti-vax as well and are very much into natural healing. Unless of course medical intervention is necessary. There's so many things that the hospitals think are necessary that I don't agree with. I would've had my last two children at home but my husband wasn't comfortable with it. He was coming around to the idea of home birthing but last night he changed his mind. He keeps going back and forth. I guess I just need to be patient and consider having someone there for his benefit. I'd really rather do it completely on my own than have others there. I handle things better when I don't have others to distract me. I understand his concerns, I just wish he'd understand my need to do it my way.
post #37 of 48
How close are you to the hospital? If it were me in that situation id either plan a c-section or rent a hotel room right across from the hospital.
post #38 of 48
Plan a c-section because there's no way in hell I could go through hours of monitoring and abuse and coercion again. I've decided this time if I go to the hospital it'll be for a c section, I don't think my hubby is too crazy about hb or UC either, but he didn't suffer from 5 months of PTSD and almost have his professional reputation ruined permanently either, I did. So again, my body mt choice.
post #39 of 48
I can't imagine what it would have been like if I'd had to birth at the hospital this past time. I just feel so strongly in my beliefs the more and more I learn. The thought of having to battle an ob while in labor would have been traumatizing and stressful in itself for me. You
Do what's right for you and your husband and baby. I hope that if you end up birthing in hospital that at least you can get a mw or doula for support and to help you fight battles as well. It's just not a time for a woman to be stressed out. Stress in itself can be labor hindering of course.

Viola-this is totally deja vu! Haha
post #40 of 48
Thread Starter 
I really really want to avoid a c-section. There's so much I hate about having a c-section. Like they take the baby away and you have to wait an hour to hold him/her. I can't handle pain meds at all, I'm a lightweight. I'm a small person too so that doesn't help, 5' 3" and about 130 lbs pregnant. Recovery wouldn't be so bad if it was only me and a newborn, but I have a 6 year old, a 3 year old, and a 20 month old. Plus we have several pets, two dogs, 3 cats, and I have pet birds as well. My house isn't a mess like you'd think either lol. It gets a little unorganized at times though. My husband can only take a week off. I don't really have family to come help either, they all have full time jobs. So a repeat c-section isn't the best option. I can go on forever about why I want to avoid a c-section. I will hire a doula and do a hospital birth if it comes down to it. She would have to be a strong willed person to be able to help me get the best experience I can at the hospital. A uterine rupture does not scare me at all. I'm slightly higher risk since I've had two but the vbac in between lowers the risk too. I told my husband I will talk with a doula and find out what she would be able to do and then go from there. I'll be honest I thought UC'ers were all crazy at first. But it fascinated me and the more research I did the more I wanted to do it myself.
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