Originally Posted by cav2
Just to portray the other side of the issue... (I am an OB resident - hiss hiss, right?). Policies surrounding VBAC are complicated, and set up to protect YOU and YOUR BABY. VBAC after 1 CS is relatively low risk, and where I practice (in Canada) we do regularly encourage TOL to low risk patients. However, I don't think any birth attendant would consider a VBAC after 3 CS low risk, even if you have had a successful VBAC since - the risks of uterine rupture (approx 10% I believe) are high enough that currently it is not "recommended" to have a TOL in our institution (though not forbidden), but definitely discouraged to have a TOL outside an institution not set up to do an emergency CS within 10 mins. The chances of uterine rupture are approx 1/10 "births" - therefore, your risk with this delivery is just as high risk as your last VBAC after 3CS. Having had a successful VBAC does not make you low risk. The consequences of a uterine rupture happening at home (even if somewhat rare - which I would not consider 10% rare but that is JMO) could be life altering - death of the child or mother from hemorrhage or shock, or severe fetal hypoxia leading to permanent brain injury (ie. cerebral palsy) for the baby. So, it is sort of a russian roulette you take on your baby's and your own life if you chose to do this at home...
I am not trying to discourage you from having a VBAC, but please, for your health and safety, and the safety of your unborn baby, please consider doing it in the hospital, even if that means you are under the care of an OB rather than a MW and you may or may not be able to have a water birth (depending on the hospital). In the long run, a healthy baby and a healthy mom are more important than "the perfect birth". Please trust me, I have seen some horrible outcomes in situations similar to yours because the woman was so determined not to have a hospital birth, and though it seems like the OBs are just being jerks and trying to get you to have a repeat CS, they really are looking out for your best interest IMO. Any OB or MW who tells you NOT to worry based upon your history should not be trusted IMO - you ARE high risk.
So, this will probably cause a rant/retaliation, but just think hard before making such a major decision. In 10 years, how you had your baby will be less important than that you have a healthy baby and you are alive to enjoy him or her.
Just my 2 cents.
O.k. Cav--Let me address my concerns and we can continue this dialogue. First, I want to tell you that I respect your opinion, however, it's not as cut and dried as you make it seem.
1) You are an OB resident and that is nothing to hiss about. You undoubtedly have worked hard to get to where you are at. I hope that you will be more open-minded than most OB's are these days and actually research the benefits and risks of VBAC fully.
2) You mentioned that policies surrounding VBAC are complicated and that they are in place to protect ME and MY BABY. I respectfully disagree with you. My personal experience (and that of many other moms) is that the OB's are MORE concerned with covering their a$$es than to keep me and my baby safe. It's simply safer for THEM to cut me open, than to take a chance that something will happen during my birth. While there are some out there who are genuinely concerned with the whole person, I would argue that the vast majority are not. They figure that the woman will "get over" the section and move on with her life with a healthy baby. All is well that ends well, right? WRONG. Just ask some of the mom's here (including me) who have serious birth TRAUMA due to an unnecessary abdominal surgery. I hope that you will develop into an OB who can look at the whole woman--her physical, emotional, and spiritual needs during pregnancy and delivery and I truly hope that you will not cut a woman unnecessarily EVER.
3) I believe you are mistaken on the 10% rupture risk. I spent hours and hours pulling and reading medical journal articles. There is very little written about VBA3C, but enough IS written about VBAC in general and VBA2C to extapolate the data for MY risk of UR. Now, it's been about 2 1/2 years since I did all my research, and my memory isn't the greatest. If I remember correctly the rupture rate after one section is slightly under 1%, after 2 sections it goes up to .9%-1.2% and after 3 sections the range is between 1%-1.7%. Again, I'll have to dig out all my articles and sit down with PubMed to confirm all of this, but I can tell you that if my risk remotely resembled 10% that I wouldn't have gone for my initial VBAC!!!
4) I'm not suggesting that having had a VBA3C makes me "low risk", but there is a school of thought that once a uterus is tried by VBAC, that the risk decreases dramatically.
5) Let's define risk as well. Risk of what? I've already suggested to you that my risk of UR is relatively small. My risk of mortality and morbidity goes WAY up in a hospital setting (especially with providers who are more interested in CYA than my well-being). My risks of serious complications from surgery are there and they are greatly decreased by a vaginal delivery.
My chances of a VBAC are exactly 0% and exactly 100%. Either I will do it or I will not do it. What will increase my chances of being successful? Certainly not what some of my providers are recommending--Full-time monitoring, no food or drinks, no mobility. My chances are very much increased by not having parnoid people around me during labor, but people who will watch for signs of distress with me or my baby and act appropriately IF IT IS NEEDED. My chances are increased with every intervention that I decline. The logical conclusion then, is that if I cannot find someone who is willing to work with me (like I had last time), then I MUST take things into my own hands for the health of ME and MY BABY.
6) My birth experience is extremely important to me and I'm not going to allow someone who has unfounded fears to ruin it for me. Yes, it's horrible when a UR happens and better for it to be in an environment where someone could help me in the event that there is a problem, HOWEVER I am not going to risk another unnecessary surgery (LIKELY to happen in my current situation). I could die from that as well. We all take risks in life and I believe that mine is a calculated risk. Until healthcare providers can start REALLY listening to their patients wants and needs, then people will continue to stay at home.
BTW--there are plenty of kids who end up with hypoxia and CP BECAUSE of OB error, who, if they were left alone or at home would have a perfectly NORMAL babe.
More later, my duties call.