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1 in 200 is not a small risk - Page 2

post #21 of 41
Quote:
Originally Posted by pamamidwife
nobody really has solid evidence about what the true risk of a catastrophic rupture is - that is, a rupture that endangers the life of the baby.

what is included in those stats are small windows that have opened in the scar long before labor. those small windows are benign and the only way they are ever seen is through a repeat cesarean. it is suspected that many women preg after a cesarean have these small windows in their scars without any stress or issues with their babies (unless the placenta is implanted over the scar, of course). labor does not make these dehesciences, but just strain of pregnancy in general.

I don't buy the `1.7% rate, for what it's worth. That's because I don't feel like many women get a true natural, uninterfered with birth that will reflect an honest statistic. Besides including the window rates in the "rupture" rate, the incidence of full blown catastrophic rupture is extremely rare....much less than 1.7%.

But, everyone has to evaluate risk on their own. It has to be what you're willing to do and live with. However, there are stats for everything...and some throw them out there to make an arguement for their own bias.
The 1.7% includes those that had cytotec and pitocin. The most accurate stats for unaugmented labor are .5% - or 1/200! And no, those are not all catastrophic ruptures. Many are 'failure to progress - c/sec - WHOA! uterus is found to be ruptured' or a similar scenario.
post #22 of 41
Quote:
Originally Posted by pamamidwife
I don't buy the `1.7% rate, for what it's worth. That's because I don't feel like many women get a true natural, uninterfered with birth that will reflect an honest statistic. Besides including the window rates in the "rupture" rate, the incidence of full blown catastrophic rupture is extremely rare....much less than 1.7%.
This was a point I got stuck on in the op too.

Studies formed to come up with these percentages are often skewed.

I would be more interested in seeing a REAL study done where the births are all drug free and natural, and then see the percentages based on that.
post #23 of 41
Beth, (Egoldbr) --I am so sorry for the loss of your precious daughter Leah.
post #24 of 41
Beth, I am also sorry to hear of your loss
post #25 of 41
I was like the OP, I really struggled the entire time I was pregnant with dd#2, couldn't decide which was better in our situation: a 2nd c/s or a VBAC. Finally I decided that for me personally, I felt safest trying for a VBAC in a hospital. It was the right decision for me. My best advice is to research, talk with your HCP and make the best decision you can for you/your baby.

I'm glad this board is here; the current climate seems to be anti-VBAC (although really more for legal reasons than medical ones IMO) and I think its very important to hear/read everything and make up your own mind
post #26 of 41
Sorry for the thread hijack, but I had a look at the link to the British article posted by egoldber and couldn't make sense of their data. (Yes, I almost failed Stats 101 a few years ago).

Could someone out there break it down?

Maternal age (adjusted odds ratio=1.22 per five-year increase, 95% CI: 1.16 to 1.28).
Maternal height (adjusted OR=0.75 per five-centimeter increase, 95% CI: 0.73 to 0.78).
Expecting a male baby (adjusted OR= 1.18, 95% CI: 1.08 to 1.29). The study did not explain the gender difference.
No previous vaginal birth (adjusted OR=5.08. 95% CI: 4.52 to 5.72).
Prostaglandin induction of labor (adjusted OR=1.42, 95% CI 1.26 to 1.60).
And birth at 41 weeks gestation (adjusted OR=1.30, 95% CI 1.18 to 1.42) or 42 weeks gestation (adjusted OR=1.38, 95% CI: 1.17 to 1.62) compared with 40 weeks gestation.

Egoldber claimed to be "older and shorter," but how old and how short must one be to get how much risk? Where do the tables begin and end?

Thanks for any help with this.
post #27 of 41
Quote:
Originally Posted by Storm Bride
Isn't that just sick? They have no idea what a woman's life is like or why she might want more kids. And, why do they persist in seeing major surgery as the "safe" alternative???
Because they feel more in control with a surgery, where they feel like they are controlling the circumstances. When a woman's body is working on it's own, they are not in control. Hence, it feels safer for them (aside from the legal considerations, which of course, point to c/s from their point of view in a big way).
post #28 of 41
I actually have a lot of sympathy with the doctors on the legal front. I wouldn't much care for it if I went ahead and supported a woman who desperately wanted to VBAC, then she turned around and nailed me to the wall in court if something went wrong. Plus, there's not much they can do if their malpractice insurers won't play ball. But, it's so disgusting that it's ever reached this point.
post #29 of 41
Does anyone have any stats on your chances of successful VBAC if you have already had one successful VBAC?

I had vaginal birth 1997
C-sec 2000
VBAC at home 2003
Due to try another VBAC at home 2 weeks from now

I dont know if this is OT, I just was getting into all the stats!
post #30 of 41
Quote:
Originally Posted by Storm Bride
I actually have a lot of sympathy with the doctors on the legal front. I wouldn't much care for it if I went ahead and supported a woman who desperately wanted to VBAC, then she turned around and nailed me to the wall in court if something went wrong. Plus, there's not much they can do if their malpractice insurers won't play ball. But, it's so disgusting that it's ever reached this point.
Sure, I don't expect them to put their careers on the line for me. That's one reason why I'm HBACing. Nonetheless, if for whatever reason I have to deal with a doctor, in a push between them and my baby and I, it's going to be baby and me. I'm not going to change my family planning or have unnecessary surgery just because it's more convenient for them.

On the other hand, the legal thing is exaggerated somewhat-- truly informed women who choose VBAC really understanding the real numbers and risks, how relative those risks are to other risks, the risks of induction and so forth, and who are treated with respect by their care provider, are much less likely to sue. Part of the suing is a result of the god auora doctors and society have created for them, lack of true informed consent (which requires probably a 2 hour conversation rather than a 20 minute one) and their technology as well as callous treatment.
post #31 of 41
Quote:
Originally Posted by Mama to 4
Does anyone have any stats on your chances of successful VBAC if you have already had one successful VBAC?

I had vaginal birth 1997
C-sec 2000
VBAC at home 2003
Due to try another VBAC at home 2 weeks from now

I dont know if this is OT, I just was getting into all the stats!
I don't know the stats but definitely your chances of success go up and your chances of uterine rupture go down, both by significant margins.
post #32 of 41
I have been researching my risk of dying from a blood clot in a new pregnancy (after threats of this from medical folk lately) and have been reading succesive reports porduced in the UK collating reasons for maternal death. Apparently, the UK is one of the few countries which actually logs maternal death and distributes the findings to health care providers. All the midwives I have spoken to are aware of the triennial reports.

It contains a page discussing uterine rupture and the fact that it was much more common in the past. In the past 3 years it appears that no mothers have died from it.

http://www.cemach.org.uk/publication...002/wmd-08.htm

I know that you are probably more concerned about your child's chances in the event of a rupture more than your own, but we forget that we are mortal too.

I think that the data are reliable but I do have one caveat; medicalisation of birth has not reached such drastic levels over here so the data may be less applicable to your circumstances if you are in a more managed situation.

My heart goes out to those of you who know that doing everything 'right' is still no guarantee.
post #33 of 41
Bohomama, the online article doesn't list the baselines, so there is really no way to see if you fall into those categories. Most researchers will send you a reprint of the actual published article for free though. And that most certainly will have the baselines listed.

Beth, I've read your posts over the past couple of months over and over and am so sorry for your loss. They have really, really made me think about my decision to VBAC.

It always boils down to me though that I have a 4 year old to think about as well. So the risk for maternal death during a scheduled c-section is almost double the risk of uterine ruputure. Worst case scenarios - I end up running around the choice of having 2 motherless children or an infant who dies but one child with a mother. And considering the risk of 2 motherless children (scheduled cesarean) is almost double that of an infant who dies (VBAC with uterine rupture), then I always end up choosing VBAC.

It's almost an impossible choice to make, especially since I have never had an infant die so have no idea of the emotional impact of that other than reading others' accounts.
post #34 of 41
Is the risk of maternal death during a c/s really TWICE as high as risk for uterine rupture? I had always read that maternal death was very rare, twice as likely with a c/s, but still extremely rare. More common in emergency sections than in planned ones.

I found this just now:
"Maternal death (very rare). The overall risk of death for women who have a planned cesarean delivery is very low (less than 3 in 100,000). Most cesarean-related deaths are after emergency deliveries (30 in 100,000).1" Here`s the link, feel free to challenge it with a better link, its all I could find, http://www.questdiagnostics.com/kbas...n8162/sec6.htm


I know that there is some disagreement here that 1 in 100 is not indicative of severe uterine ruptures, still it looks like comparing u/r to c/s death of mom is not apples to apples.

Beth, I also have read everything you`ve written here and I feel for you so much. I want you to know you are not alone in researching the cause of your daughter`s death. I lost my son to severe shoulder dystocia in a hb, also doing "everything right." I still read about shoulder dystocia sometimes now. I also feel that most births are safe, even vbacs and hb`s with known-to-be-big babies, I also have a hard time encouraging these things, mostly I stay out of it. The chances are small of a disastrous outcome. I think the chance of a fatal shoulder dystocia is something like 1 in 30,000. Well, when it happens to you the chance is 100% so it means nothing. I `m not trying to take over and talk about me, I don`t even know what I`m trying to say exactly, jut that I`m glad you wrote what you did.
post #35 of 41
I don't like reading UR stats, because they're not really relevant. The way I see it, each woman, in each delivery, has either a 100% chance or a 0% chance of rupture. I wish to hell we had a way to know which applies to any given woman...

Beth: Like others here, I've been reading your posts, and I don't have the words to say how sorry I am. Nobody ever likes to think about the possibility that they could lose a baby, but we all know that it does happen.
post #36 of 41
I was going off of the famous study in the NEJM published last year. The way I understand it, 2 (.01%) of babies died from a UR. But there were 7 (.04%) maternal deaths resulting from cesarean surgery. Here's the link to the article by David Dobbs (very well written and clear explanation IMO)

http://slate.msn.com/id/2111499/

And that actually means that risk from a cesareans is even more than double. But double is what stuck in my mind!
post #37 of 41
Wow! That is pretty shocking Girrllie. My link must be older than that most recent study. If you think about it though, the rate of any uterine rupture at all was much higher than death to mom by c/s. .7 vs. .04. Most moms do have more minor u/r (out of the ones that do rupture) and the truly tragic ones are still rare, but its hard to know which will happen.
post #38 of 41
Quote:
Originally Posted by girrllie
And that actually means that risk from a cesareans is even more than double. But double is what stuck in my mind!
I think it depends on what you're comparing honestly. In that study, in the TOL group, 2 babies died and 7 had HIE (essentially brain dead or extremely limited brain function). In the ERCS group, there were 0 cases of HIE. In the TOL group, there were 3 maternal deaths. In the ERCS group there were 7 maternal deaths.

While only 2 babies died, many HIE children have extremely low or no quality of life. Technically, my baby did not die from my VBAC attempt. She had HIE. Which in our case meant no brain function, her pupils were fixed and dilated from birth, and we basically had to make the decision when to take her off the ventilator. You can read about HIE here:

http://www.emedicine.com/ped/topic149.htm

My take away from the NEJM study (both before my VBAC attempt and now) is that ERCS and TOL are basically equivalent in terms of safety. At the time, I too thought that the tradeoff on risk for maternal death (and other things) was worth the VBAC attempt. Of course, in retrospect, I am not so clear on that decision. I am happy to be alive, but there is guilt I will carry with me the rest of my life.

I would encourage everyone to read the NEJM article for themselves rather than relying on interpretation from others. It has very clear charts and is well written IMO. You can access the article at the NEJM website. Since the article is more than 6 months old, you can register and read it for free.

http://content.nejm.org/content/vol3...25/index.shtml
post #39 of 41
Quote:
Originally Posted by girrllie
I was going off of the famous study in the NEJM published last year. The way I understand it, 2 (.01%) of babies died from a UR. But there were 7 (.04%) maternal deaths resulting from cesarean surgery. Here's the link to the article by David Dobbs (very well written and clear explanation IMO)

http://slate.msn.com/id/2111499/

And that actually means that risk from a cesareans is even more than double. But double is what stuck in my mind!

Which brings us to the real problem, too many unneccessary c-sections.
post #40 of 41
"While only 2 babies died, many HIE children have extremely low or no quality of life. Technically, my baby did not die from my VBAC attempt. She had HIE. Which in our case meant no brain function, her pupils were fixed and dilated from birth, and we basically had to make the decision when to take her off the ventilator" -egoldber

This is an excellent point. I also noticed this when I read the study. Our son lived for 7 weeks with HIE. Most babies who suffer a severe brain injury at birth live to be 3 years old at the oldest (on average). The study didn`t follow the other babies.
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