"More Moms Dying from Cesareans" Why would you NOT VBAC????

[Tummy]

A recent study that shows the rate of death from cesareans is triple that of women who give birth vaginally. What this new study really shows is that the deaths were not from pre-existing conditions. In fact , these deaths, mostly from infection, blood clots and complications with their anesthesia.

http://http://pregnancy.about.com/

[Tummy]

Be sure to check out the What to do if You're Denied a VBAC

[Finch]

"More Moms Dying from Cesareans" Why would you NOT VBAC????

...never mind.


:

[JanetF]

Like Marsden Wagner says, if women are choosing c-secs someone is lying to them. Sadly most women don't actively choose, they get a bad system and then a worse anti-vbac system. Once you have the HUGE list of potential problems from surgery in front of you and the very small list of potential problems for the normal physiological process it seems pretty clear which is safer for you and your baby.

[wifeandmom]

Comparing vaginal delivery to c-section is different when it's a VBAC compared to ERCS. The stats simply aren't one and the same.

More women die from ERCS vs. VBAC attempt.

However, more babies die from VBAC attempt vs. ERCS.

Perhaps women are choosing to take the risks of ERCS for themselves to lower the risk of death to their baby?

Off to find handy chart of stats from the NEJM study published just under two years ago that studied this very thing.

[wifeandmom]

Here we go, just posted this last week. If you like, you can register for free to have access to the entire research article, including all of the tables that were truly fascinating, from this study.

The first number is risk during VBAC, the second is for ERCS.

So, VBAC vs. ERCS stats were found to be as follows:

UR: 0.7 vs. 0

Dehiscence ('windows', but are NOT life threatening): 0.7 vs. 0.5

Hysterectomy: 0.2 vs. 0.3

Thromboembolic disease: 0.04 vs. 0.1

Transfusion: 1.7 vs. 1.0

Endometritis: 2.9 vs. 1.8

Maternal death: 0.02 vs. 0.04

Other maternal adverse events: 0.4 vs. 0.3

One or more of the above: 5.5 vs. 3.6

These are number for MOM, not talking about baby at all. Overall, mom experienced more complications during VBAC (5.5%) than they did with ERCS (3.6%).


Numbers for BABY looked like this, again VBAC vs. ERCS:

Hypoxic-ischemic encephalopathy (severe brain damage): 0.08 vs 0

Neonatal death: 0.08 vs. 0.05


In real numbers, they had 3 dead moms after VBAC, 7 dead moms after ERCS. So, yes, ERCS was found to be riskier for mom in terms of death.

In real numbers, they had 13 dead babies from VBAC, 7 dead babies from ERCS. So, VBAC was riskier in terms of death for baby.

So...again, maybe some women look at all of that and think 'They are all such small numbers, it's worth the risk to attempt VBAC even though more babies died as a result in this study.'

And that's a perfectly logical thought to have.

I don't happen to share that thought, as I'll take on the added risk of maternal death every day of the week and twice on Sunday to avoid putting that risk on my unborn child, no matter how small the numbers are.

BUT, the numbers ARE small, so really, either choice seems perfectly valid and certainly not something to be up in arms about or shocked over how someone else could arrive at a different conclusion looking at the same information.

[wifeandmom]

Originally Posted by JanetF

Like Marsden Wagner says, if women are choosing c-secs someone is lying to them.

Do you not believe the findings published in the NEJM? The study itself was set up using sound research principles, and the numbers don't lie.

Sadly most women don't actively choose, they get a bad system and then a worse anti-vbac system.

This part is absolutely true. Many times it's not a choice mom GETS to make whether or not to VBAC, unless she is willing to do so unassisted. That's a shame really, as I am a big believer in choice, regardless of whether or not I agree with that choice.

Once you have the HUGE list of potential problems from surgery in front of you and the very small list of potential problems for the normal physiological process it seems pretty clear which is safer for you and your baby.

If we're talking vaginal birth vs. c-section, sure. If it's a look at risks for VBAC vs. ERCS, it's no longer a 'normal physiological process' because the scarred uterus is no longer 'normal' and there are risks associated with that fact. I put the list in my previous post of actual complications found in women who attempted VBAC vs. those who elected for ERCS. The ERCS group experienced LESS complications overall than the VBAC group.

Again, the numbers don't lie, but it is crucial to realize that EITHER set of numbers is very low.

[aran]

Originally Posted by wifeandmom

So...again, maybe some women look at all of that and think 'They are all such small numbers, it's worth the risk to attempt VBAC even though more babies died as a result in this study.'

And that's a perfectly logical thought to have.

I don't happen to share that thought, as I'll take on the added risk of maternal death every day of the week and twice on Sunday to avoid putting that risk on my unborn child, no matter how small the numbers are.

BUT, the numbers ARE small, so really, either choice seems perfectly valid and certainly not something to be up in arms about or shocked over how someone else could arrive at a different conclusion looking at the same information.

Absolutely. DH and I came to the exact opposite conclusion. First, I would rather have no-one die, of course. But I believe it would be irresponsible incur the greater maternal death risk of ercs, with the ramifications of leaving DH with no parenting partner and DS with no mother. This may sound so so so horrible, there are people relying on me in this world and I refuse to take that risk. I guess that sounds like a decision that's selfish, but it was not made for selfish reasons. Free choice (between vbac and ercs) is a wonderful thing, because it can accomodate our different ways of appraching these issues.

[MommytoTwo]

I believe it would be irresponsible incur the greater maternal death risk of ercs, with the ramifications of leaving DH with no parenting partner and DS with no mother. This may sound so so so horrible, there are people relying on me in this world and I refuse to take that risk. I guess that sounds like a decision that's selfish, but it was not made for selfish reasons.

Ditto that. I am sorry and I know it sounds terrible, but if there is a choice to be made between myself and my unborn baby, I am going to choose myself only because I wont leave my very young children without a mother, and my husband without a parenting partner. My choices may have been different the first time I was pregnant with no kids already but things are different.

[~member~]

Originally Posted by wifeandmom

More women die from ERCS vs. VBAC attempt.

But what's the difference between VBAC and scheduled c-sections?

[DreamsInDigital]

But if the mom dies, then usually so does the baby.
How does that make an ERCS better?

[~member~]

Originally Posted by DreamsInDigital

But if the mom dies, then usually so does the baby.
How does that make an ERCS better?

I would think that a scheduled c-section would be less risky than an emergency c-section....but I haven't seen any numbers.

[midwifetx]

But if the mom dies, then usually so does the baby.

Not if the mom doesn't die until there are complications arising from her surgery (usually days later)

[wifeandmom]

Originally Posted by DreamsInDigital

But if the mom dies, then usually so does the baby.
How does that make an ERCS better?

Not according to this particular study.

With VBACs, there were 3 dead moms and 13 dead babies. There were an additional 13 or 14 babies with severe brain damage after VBAC.

With ERCS, there were 7 dead moms and 7 dead babies. There is nothing to indicate that the dead moms and dead babies were pairs, meaning if mom died, so did baby. And I'd think it incredibly unusual for that to be the case anyway since most women who ultimately die as a result of ERCS will do so well AFTER the baby is already delivered.

Mom is usually going to hemorrhage during the section, die of an infection or blood clot afterwards, or some such complication, none of which would affect baby in the least cause, well, baby is already out by then.

[wifeandmom]

Originally Posted by MommytoTwo

Ditto that. I am sorry and I know it sounds terrible, but if there is a choice to be made between myself and my unborn baby, I am going to choose myself only because I wont leave my very young children without a mother, and my husband without a parenting partner. My choices may have been different the first time I was pregnant with no kids already but things are different.

It crushes me to even consider the three children I already have being without a mother. Truly, it does. I've broken down into tears just thinking of it...darn pg hormones don't help a bit.

BUT, I would die a million times over for any one of them. And that includes this baby growing inside me. She is just as much my child as the one's sitting on the couch reading books right now.

And I would hope that one day, each of them would understand that I would *never* have had it any other way. If someone is going to die during delivery, it dang well better be ME.

My father's mother died 9 days after he was born. He struggled with feelings of guilt for 50 years over this. When he was 50, I became a mother myself. We talked about the guilt he had felt all those years while I was pg the first time. I couldn't believe it had never occurred to him that his mother would have died for him a million times over willingly to know he was safe. I asked him if he would die for ME, his daughter, if it came down to it. Of course he said 'yes'. It was truly like a lightbulb went off in his head and he finally associated HIS protective parental feelings with what his MOTHER was likely to have felt.

This feeling of 'I'd rather it be my baby that dies than me' is odd to me, although I wouldn't call it selfish really. Our sense of self-preservation is strong, so strong as to make feelings like this possible I guess. And in the end, if it's how you feel, then you truly ARE better off statistically going with VBAC cause MOM is safer from death with that choice. Of course, overall complication rates for VBAC is higher, but mom ultimately dying...VBAC would be the safer of the two, although not by much (2 in 10,000 vs 4 in 10,000).

[Lkg4dmcrc]

Originally Posted by wifeandmom

This feeling of 'I'd rather it be my baby that dies than me' is odd to me, although I wouldn't call it selfish really. Our sense of self-preservation is strong, so strong as to make feelings like this possible I guess. And in the end, if it's how you feel, then you truly ARE better off statistically going with VBAC cause MOM is safer from death with that choice. Of course, overall complication rates for VBAC is higher, but mom ultimately dying...VBAC would be the safer of the two, although not by much (2 in 10,000 vs 4 in 10,000).

The thought of I'd rather have it be me and leave my children motherless rather than the unborn baby die is odd to me. I guess that is what makes us all different. My dad's mom died when he was little and he grew up with some terrible issues because of it- all sadly passed on to his children. I cannot imagine leaving any living children motherless. For me personally, it has nothing to do with self-preservation. It is more about not leaving my living children to grow up without a mother!

[aran]

Originally Posted by Lkg4dmcrc

For me personally, it has nothing to do self-preservation. It is more about not leaving my living children to grow up without a mother!

Thanks. That's what I was trying to say. The feeling of self-preservation never entered my mind when the decision was made. This was also DH's preference, 100%.

[wifeandmom]

Originally Posted by Lkg4dmcrc

The thought of I'd rather have it be me and leave my children motherless rather than the unborn baby die is odd to me. I guess that is what makes us all different. My dad's mom died when he was little and he grew up with some terrible issues because of it- all sadly passed on to his children. I cannot imagine leaving any living children motherless. For me personally, it has nothing to do with self-preservation. It is more about not leaving my living children to grow up without a mother!

I guess I just look at this baby growing inside me and think of her as my child, just as real as the ones I already have already brought into this world.

At what point would you say you'd be willing to sacrifice your own life, and thus your other children having a mother, for your new baby? I am assuming, of course, that if someone came in and made you choose between YOU dying and one of your existing children dying, you'd choose to die yourself? Or would you choose to allow your existing child to die, thus leaving the rest of your children with a mother?

And really, if your unborn child were dying inside of your body, would you refuse an emergency c-section to save that baby's life? Because an emergency section certainly carries greater risks (according to every other study out there at least) for mom than a scheduled one. Would you insist on continuing to deliver vaginally to avoid the risks of section for yourself, or would you be willing to take on those risks in the face of imminent danger of death or harm to your unborn baby?

I'm thinking the hesitation to assume the increased maternal risk of death with ERCS comes more from the fact that baby is not in imminent danger at the time of ERCS, whereas during emergency c-section, consenting at that point is because the unborn child IS at immediate risk. Does that make sense?

I guess for me, I personally couldn't live with myself if I knew that I chose myself over my child, and that includes children growing inside me. The only time I could see choosing my own life over that of my child would be if the unborn child in question wasn't viable to begin with, at which point it's not really a choice between my life and my child's life, as my child wouldn't live regardless of my choice.

Anyhow, I'm truly fascinated to read how others come to make their own decisions.

[wifeandmom]

Originally Posted by aran

Thanks. That's what I was trying to say. The feeling of self-preservation never entered my mind when the decision was made. This was also DH's preference, 100%.

So it's more about protecting your living children, not so much about protecting your own self. I can see that.

I just look at this child growing inside me as just as important as my living children.

I'd die for any of the three sleeping in my house right now, leaving all of them motherless, rather than choosing to allow one of them to die and keeping myself alive for the remaining two.

The child inside me is just as important, just as loved, just as significant and worthy of sacrifice as my other three. I'd do whatever it took to protect her, to keep her safe, just as I'd do all of these things for my living children.

The only thing I would NOT ever do would be choose between my children, much like whatever that horrific movie was during WWII...Sophie's Choice or something like that. We'd all have to die, cause I'd *never* choose which child lived and which one died.

[rn]

Anyhow, I'm truly fascinated to read how others come to make their own decisions

I find it fascinating also, especially those of you that seem to have come to such a strong conclusion regarding leaving your living children and partners motherless.
I dont believe anyone can make such an intense decision without it actually happening to you. Sure it is something to think about, but unless you know what it is like to have to bury your baby and then go on living without that person in your life... well like I just said, you need to walk in those shoes and then see what you would do.

Having experienced this first hand (failed vbac) I can say that I would much rather have died instead of my baby. Sadly I did not have that option, but believe me when it was happening if I were given the choice I would not have thought twice about it, "yes, please take me instead". My living child and partner and my baby would have been fine without me. Like some of you have already said, human survival instincts are very strong. Yes, my baby would have been fed formula but there are far worse fates then that.