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scoring system for VBAC chances?

post #1 of 12
Thread Starter 
I've been reading aboug VBACs through this website http://www.childbirthconnection.org/

One section reads:
"VBAC is associated with risks and trade-offs, so deciding whether to give birth vaginally after c-section is a choice that only you can make. It may help you to know, though, that some doctors developed a scoring system to try to identify the likelihood that a woman would end up having a vaginal birth, from 0 (least likely) to 10 (most likely). As expected, almost all women scoring 8 to 10 had vaginal births, but half the group scoring 0 to 2 still gave birth vaginally. Studies that have looked at such factors as suspected big baby, slow or stalled labor as the reason for the previous cesarean, going past the due date, more than one previous cesarean and others have found that despite these disadvantages half or more of women who planned VBAC achieved their goals."

Does anyone know about such a scoring system? It is purely in the medical model as it does not take into account labor support, setting, epidural and so forth, but I'm still curious.

For those who have VBAC'd successfully, what factors helped you the most?
post #2 of 12
I've not heard of a scoring system for VBAC chances. Don't know where you are in NY but I'm on Long Island and had my second baby, a successful VBAC, at Stony Brook w/ the CNMs there. Pretty good experience, but I am having a homebirth, attended by a CNM, for my third (due 10/06).

I think it's great you've been doing research - arming yourself with as much information as you can is, in my opinion, the best possible thing you can do. I will tell you up front that I am a bit of a medical heretic. I have come to believe in recent years that a great deal of what modern medicine does - esp as pertains to pregnancy & birth - simply does not make sense biologically. Research frankly bears this out in any number of ways, not the least of which is that here in the US we have one of the highest intervention rates in labor and birth, as well as pretty much THE highest maternal & infant death rate of any developed country in the world (this hit the news recently, about one month ago, but has been reported once-yearly for several years now as it doesn't seem to change). I truly believe (as do most midwives) that pregnancy and birth are normal, natural experiences for a woman - but medical science, and in particular most OBs, seem to treat pregnancy like it's a nine month disease that you can't be rid of without their help.

One thing I have consistently found in my reading over the past 4-5 years is that doctors are always keen to mention risks associated with VBAC but they typically never mention that c/s has statistically much greater risks associated with it - beginning with a 20% chance of infection for ANY surgery in a hospital. Many OBs claim to be supportive of VBAC but they end up finding every reason they can to discourage it rather than helping you to feel empowered and believing in your body's natural ability and design. Oh, and btw, my first baby was delivered c/s because of the old standby classic, failure to progress, which supposedly is something that makes a VBAC less likely next time around.

If I may recommend some more reading, that I found very helpful and empowering:

International Cesarean Awareness Network
http://www.ican-online.org/

Ina May's Guide to Childbirth, by Ina May Gaskin (world famous midwife)

The Thinking Woman's Guide to a Better Birth, by Henci Goer (LOTS of info and stats on VBAC)

One last thing - in most other developed countries, healthy pregnant women are seen by midwives, not OBs, and VBAC is treated as the NORM, not something that they may or may not give you the privilege of trying. Vaginal birth is seen for what it is - the way that nature and your body were designed to bring a child into this world. Biologically speaking, while c/s has its place in true emergencies, it just doesn't make sense as a scheduled event when labor and normal birth have not been given a genuine, supported chance to succeed.

Good luck in your research!

Heidi
post #3 of 12
This may be what you're looking for:

http://www.obgyn.net/jr/jr.asp?page=review17
post #4 of 12
FYI, my DH found a study that had a scoring system for VBAC, and did calculate my chances, but to be honest, I don't think it is a very helpful predictor of anything. As you point out, it doesn't talk about labor support, and other things which we all know to be key factors in a successful birth of any sort, let alone a VBAC. I found it a bit demotivating and again it put the whole thing into "clinical" vs. "personal" terms. It is kind of like trying to predict success on a job. There is the resume of the candidate (how they look on paper) and then there is the actual person and what they truly bring to the experience. I do think wanting to know what are the greatest factors in successful VBAC's is an incredibly important question and something that I am trying to get a sense of as well. If you find any good resources, please post! Good luck with everything.
post #5 of 12
Well, I took the "test" and got a 2 (I'm 39, not 40) Gee, don't I feel great. :
Thank you for posting it though. Although it isn't really set in stone, it is better to be prepared with all information, even the info you don't like.
post #6 of 12
Well, I was basically a 2 for my 1st VBAC, and it still happened. Don't worry about it too much.
post #7 of 12
I'm a 4, but I'd bet if I ended up a hospital I'd get another just because I'm having my baby only 11 months after my c-section.
post #8 of 12
I looked at the scoring system, and using my "stats" from before my successful VBAC, my score was a 2.

I had NO problems with labor and birth and was allowed to progress slowly and unbothered, with no drugs or other interventions.

It might be worth noting that in most other developed countries, VBAC is considered the NORM and there is no "option" for "letting" women attempt a vaginal birth - vaginal birth is accepted as the norm and even after a c/s women at least begin labor expecting to birth their children vaginally. True emergency c/s is rare, even with VBAC - most "failed" VBACs end up as c/s because the OB becomes impatient with mother nature, and oftentimes they only appear to be supportive of VBAC but in fact have a very low success rate because they don't truly allow normal, natural labor to proceed.

Hope I'm not repeating myself... been thinking entirely TOO much lately about all kinds of birth issues and getting all ticked off at the ALL-too-frequent unnecessary interventions! :
post #9 of 12
I am a 5 (age, effacement and dilation). Since "at admission" seems irrelevant I used the max numbers I reached before the surgery.

Oana
post #10 of 12
I'm not going to check my number, it seems to me it's probably not accurate and therefore might create more of a mindgame than anything - meaning, if it's not a "good" number, that info could just end up being part of the package of negativity that isn't helpful for a mom who wants to vbac.

If it's based partly on past labor experiences, then that would make it even less accurate in many cases - when labor was influenced heavily by the interventions that occurred, it wouldn't even be fair to give that a value as if that's what the woman's body would have done under different circumstances. I wouldn't define that number as "information".
post #11 of 12
I ran the numbers on myself and came up with a 3. My VBAC was 17 months ago and one of the best experiences of my life. I have to wonder how much was self fulfilling prophecy. Based on the factors described, the doctor probably had a pretty strong opinion of whether the woman would succeed, scoring system or not. I had a long labor and if someone had assigned me a number that told me I only had a 50% chance of success, they probably would have taken my long labor as a verification of those odds - it wasn't going to happen. In the end I labored 30 hours, pushed for 1 and a half hours and birthed a baby over a pound bigger (though with the same size head) as my c/s baby.

Ann
post #12 of 12
hmm...my score's a six. Too bad I'll be having a VBA3C (if I have another baby), which most doctors would automatically assign a score of "zero". The only risk factors (as usually judged) that I have are a history of c-sections, and "advanced maternal age" with my next (if and when). I'm 38 day after tomorrow...

You know...even the "0-2" range cites a 49% chance of successful VBAC. Those might not be great odds in some ways, but I think it really shows that this whole subject has been beated to death by the medical profession. Half of the "worst off" group can/will VBAC, even according to the OBs. So, why do they all behave as though a woman's chance of VBAC is miniscule?
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