"More Moms Dying from Cesareans" Why would you NOT VBAC???? - Page 2

[aran]

Originally Posted by wifeandmom

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.

I was considering saying something about this, but I didn't have time to open up a long philosophical discussion. I would obviously take crazy risks for my DS and would die to protect him. But when I was pg with him, I didn't feel that way. It was only later, after he was born, and not even immediately. (I know I am not alone with this unfortunate feeling. Perhaps this is a biological mechanism to protect our species, which you might only believe, as I do, if you are a Darwinist.) Of course now, our bond is extremely close - to the point that strangers make comments about it - so I guess that less than picture perfect start was no problem. Anyhow, my point is that he didn't get the same level motherly emotional support from me in utero that he did once he was alive. Now that I have a DS and know what it's like to be a mother, maybe I will feel differently about a second child in utero. I can't say. Please - no flames - I hope I don't sound too callous - I really am not.

And rn I am so so so sorry I suffered an early m/c this year and as a result have spent time in the pg loss boards. I wept many times reading the stories of full-term losses and looking at photos. I agree that I am now making the decision in a vacuum - with no idea of how I would feel should the worst befall me. But one has to make the decision about birth without knowing in advance the outcome.

FWIW, I am sticking with the vbac plans. I guess I won't discuss this with anyone IRL, because from the sound of it, I would probably come off sounding like a selfish jerk.

[Lkg4dmcrc]

rn- you are correct- we are all making these decisions in a vaccuum and if it actually happens to us, we may make different decisions or regret our decisions. To me, I see this as a philosophical discussion and never intended to imply anyone's decisions were wrong or minimize the trauma of losing a child. We all come to different conclusions on these issues, but we certainly cannot ever really know until it happens to us.

As for my unborn baby not being important- that is not true. My first was an emergency cesarean- we had to make the decisions to get the baby out fast or suffer the consequences. We made that decision and of course are happy about it. We just now have a different set of issues to think about when we go for the next child. In an emergency again, we will probably make the same decision (go for the cesarean) because we are not about vaginal delivery at all costs. But, we wouldn't assume a greater risk at an ERCS knowing that we had a toddler or other children who could end up motherless. This we don't feel is acceptable for the living child- especially given my history of growing up with a father who lost his mother at age 2.

[Meg Murry.]

Originally Posted by Tummy

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

I did a great deal of research about this issue, and whereas it's true that the rate of maternal death is higher, it's more like .0004% (repeat c) vs. .0002% (vbac) -- a negligible difference. What tipped the balance for me in the direction of a section is the fetal mortality rate. In a meta-study published in the New England Journal of Medicine in 2002, even when you adjust for things like emergency c, vbacs without drugs, et cetera, the fetal death/complication rate is substantially higher with a vbac than with a c. For me, a section was a matter of a slightly greater risk for me versus a substantially greater risk of the child dying or being permanently damaged. The ethical choice was clear.

FWIW, the data I've given you was provided by a link from an MDC mom -- not exactly a pro-section advocate. Also, my predisposition was far in favor of VBAC vs. C, so these figures and what they implied were rude awakenings.

[rn]

FWIW, I am sticking with the vbac plans. I guess I won't discuss this with anyone IRL, because from the sound of it, I would probably come off sounding like a selfish jerk.

I think that is good that you are sticking with your vbac plans. I have nothing against vbac and if I am lucky enough to have another child I would still keep a vbac as an option (yes, really), BUT not my only one. I think the buddhist philosophy of the "middle way" comes to mind for me as going to far to either side of the vbac or c section road seems to bring into play way to much arrogance on both sides. I think choosing to remain as humble as possible and allow whatever outcome occur is most important.

I agree that vbacs are mostly safe and well worth striving for, but like anything in life it does have its risks. Most people (myself included in the past) do not choose to even consider these thinking the statistics are too small to worry about. What can be frustrating is when I see titles to threads bashing mothers for "choosing" c sections and reminding everyone how unsafe they are. It frustrates me for two reasons. The first being, who are we to judge anyone for making any decision in life unless we are walking in their shoes? How can we judge anyone as we can never know all of the things that have led them to their choices? The second is I feel like the bashing of one with out bashing the other is unfair (well bashing either is unfair), they both have risks to mother and baby... any form of birth has risks. Taking "sides" is not the answer.
C sections are as safe as any other form of birth, vbac or "regular" vaginal birth in a hospital hospital at home with a midwife or unassisted. I feel it is most important to remember that birth is as safe as life itself.

[Phoebe]

I have a question...

If VBAC is riskier for baby than ERC, is it because uterine rupture causes the risk? Aren't the risks to baby similar to that of a vaginal birth with an unscarred uterus? If I am correct, vaginal birth with an unscarred uterus carries more risk for baby than for mom as well...more babies die in vaginal child birth than mothers. So what is the ethical difference in choosing VBAC over ERC? I'm sure the stats aren't exactly the same in outcome for mom and baby in VBAC vs. unscarred uterus but they are both still more dangerous for baby than csection. So with that logic, why not just choose elective csection for ALL babies and moms?
And if baby perishes due to something like prolapsed cord during a VBAC, the baby's demise isn't attributed to VBAC (statistically speaking) is it?

I'm just wondering what I'm missing here...

Amy

[wifeandmom]

Originally Posted by rn

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.

I am so sorry you lost your baby.

I know when I was pg with my twins, there was ZERO hesitation in my thinking. None whatsoever. I made it VERY clear to my docs that if someone was going to die that day, it had dang well better be ME.

When I was pg the following year with my singleton, I struggled with guilt because my sense of dedication to that child simply wasn't what it was when I was pg the first time. I would look at my twins, then less than a year old, and think 'How could I leave them without a mother?'

However, during my c-section, I had one of those experiences where I was simply convinced I was going to die. No medical reason for me to have thought this, but I was convinced I was dying. And I was ok with that. My son was out, he was safe, and I knew that THAT was what was most important to me. I told my DH to make sure they knew I loved each of them desperately, and I was ok with dying.

I look back and wonder what on earth I was thinking that day, lying on the table with NO complications whatsoever, but you could not convince me that I wasn't about to die. And the only thing that made me sad about it was knowing my kids would hurt, but I knew they were all safe and they would all be ok. I wasn't freaked out about the thought of dying at all.

It was all a very surreal experience, but one I am glad I went through because it made me realize that all the guilt I'd had over wondering if I wasn't as dedicated to my third child as I was my twins ultimately proved to be unnecessary, as I knew without a doubt I'd do the same for him as I would have done for my twins.

I have not struggled with those feelings with this current pg. I *DO* think about how sad it makes me to consider leaving ALL of my children without a mother, but that INCLUDES this unborn child as well. I'm just as sad for her as I am for my other three should the worst happen to me. She's just as important to me, and I cannot imagine choosing myself over MY CHILD, which is exactly what she is.

[MizLiz]

I'm trying to decide between a VBAC and section for my next baby... I'm interested in watching this thread. :

[GalateaDunkel]

I am strongly of the belief that I should prefer the life of any of my children to my own, and that a viable unborn child is morally equivalent to any other child. (In fact I find the use of "living" to indicate that the child is outside the womb somewhat offensive.)

But I am still planning to VBAC, for the following reasons. Primarily, I don't see an increase in statistical chances (that are infinitesimally small to start out with) as morally or logically equivalent to a direct choice that someone in the situation WILL die. Not the same thing at all.

Secondarily, barring truly extreme circumstances I will definitely get pregnant a third, fourth, perhaps even fifth or sixth time depending on my biological clock, so I have to consider the increased risk to future pregnancies from multiple c-sections. One of my strongest reasons for interest in the VBAC movement is that I will not allow the medical establishment to dictate my family size. Recently a relative, on hearing we (still) plan a large family, said "oh but they won't let you have more than 3 c/s." More striking than her "once a c always a c" misconception was her inability to morally question doctors "letting" people have children.

Furthermore, I think that some degree of preference for natural processes has to figure into the equation. Phoebe makes a good point about decreasing risk to baby through elective primary cesarean. Permanently consigning your reproductive life to interventive modalities wholly controlled by powerful professionals is physically, morally and spiritually risky. It is a choice to permanently subvert the body's natural function because technocratic medicine claims to be able to do it better. My vagina and the surgeon's scalpel are not morally equivalent objects. It is degrading to put the burden of proof on women's bodies in statistical competition with whatever intervention the system decides to come up with.

[wifeandmom]

Originally Posted by Phoebe

I have a question...

If VBAC is riskier for baby than ERC, is it because uterine rupture causes the risk? Aren't the risks to baby similar to that of a vaginal birth with an unscarred uterus? If I am correct, vaginal birth with an unscarred uterus carries more risk for baby than for mom as well...more babies die in vaginal child birth than mothers. So what is the ethical difference in choosing VBAC over ERC? I'm sure the stats aren't exactly the same in outcome for mom and baby in VBAC vs. unscarred uterus but they are both still more dangerous for baby than csection. So with that logic, why not just choose elective csection for ALL babies and moms?
And if baby perishes due to something like prolapsed cord during a VBAC, the baby's demise isn't attributed to VBAC (statistically speaking) is it?

I'm just wondering what I'm missing here...

Amy

I've never seen an actual study that compared elective primary section to vaginal birth in terms of risk to baby. We certainly know that the section is riskier for mom, and I'd honestly THINK that the section would be safer for baby...BUT I've never seen any good, solid research on it, so I can't really answer your question about that.

I'm not sure about your last question either. If a baby dies of prolapsed cord during VBAC attempt, I can see why they might include that death in the VBAC death rate simply because that baby wouldn't have died from a prolapsed cord with ERCS. They already controlled for the babies that died PRIOR to onset of labor and/or scheduled section date (which would take care of any babies that died of prolapsed cord or abruption,etc prior to onset of labor or surgery date), so the number of dead babies in each group was STRICTLY once VBAC was attempted OR ERCS was performed.

I believe the only deaths they excluded altogether were of babies that would have died regardless of delivery method, such as congenital defects not compatible with life.

As for why women shouldn't just have sections for every baby if it's safer for baby....

Well, VBAC is a bit different because you KNOW going into it that mom is at a very much increased risk of a particular complication (UR). In the unscarred uterus, catastrophic rupture is VERY rare (1 in 15,000 or less). But once the uterus is scarred, it sky-rockets to 1 in 200, sometimes a lot more than that depending on particular interventions like induction/augmentation.

We also KNOW that VBAC results in more dead babies than ERCS. It also results in more complications overall for mom, although mom is still more likely to die with ERCS.

Other potential complications from vaginal birth often cannot be predicted to such a degree. We are already seeing a lot of sections prior to onset of labor for 'big baby', with the fear obviously being difficulty getting baby out without damage, shoulder distocia, etc. Problem there is u/s is used to determine baby's size, and it's notoriously inaccurate late in pg.

We see virtually all women with breech babies being sectioned, again because it is known that breech babies experience more complications during delivery compared to their vertex counterparts.

The trade off to more sections is pretty much always going to be more dead moms and less dead babies, but the overall numbers would likely mimic the VBAC/ERCS numbers. As we can see in this thread alone, there are mothers who would choose the risk of a dead baby rather than the risk of dying themselves in the absence of a true emergency, so I don't see ALL women electing to have sections based on the very valid feelings expressed in this thread alone.

[trini]

I have not read every post on this thread. I had a hard time reading about "dead babies" and "dead mommies." But thought I'd answer the question in the thread title.

After living through the death of our first son, I was willing to take on the "extra" risk that was quoted in your study. For me a repeat c-section was worth it emotionally and physically.

I know that many on here would disagree.

[wifeandmom]

Originally Posted by GalateaDunkel

Primarily, I don't see an increase in statistical chances (that are infinitesimally small to start out with) as morally or logically equivalent to a direct choice that someone in the situation WILL die. Not the same thing at all.

You are absolutely right. The numbers ARE small, but that goes either way. The risks of ERCS are NO GREATER, and in many categories actually LESS, than the risks of VBAC. This entire thought process that VBAC is oh-so-much-safer is simply NOT supported by research. I find it fascinating that people continue to vehemently insist on how much 'safer' VBAC is for baby and mom when the reality of the numbers simply does not support that.

At best, the two are comparable simply due to the very small risks associated with EITHER choice.

Secondarily, barring truly extreme circumstances I will definitely get pregnant a third, fourth, perhaps even fifth or sixth time depending on my biological clock, so I have to consider the increased risk to future pregnancies from multiple c-sections.

THIS fact alone would likely sway me to consider VBAC if I were in your shoes. The risks to subsequent pg from multiple c-sections are actually quite disturbing, and this is very much something that a woman choosing to have a non-medically necessary section should consider in great detail.

We had twins by elective c-section knowing we wanted a third, *maybe* a fourth child somewhere down the road. I was absolutely fine with the stats on increased risk to a second pg after one c-section, and the stats for a third c-section didn't deter me either.

Had we known that we wanted five, six, or more children, my choice of elective section the first time around (although in the end, there WERE very strong indicators that a vaginal birth was unlikely at best) would not have been as much of a sure thing.

What I likely would have done would be to have the first section, again because all indications pointed to babies needing to be born, yet my cervix was not in any way even remotely favorable for induction. Then we would have made darn sure we didn't get pg again til VBAC would have at least been a consideration. As it was, VBAC less than 13 months after my first section, added to the fact that I'd have had to be induced (ruptured membranes, no cervical change whatsoever despite contracting regularly for hours, along with GBS+ status), was simply not something we even considered. Had we waited longer between pregnancies, maybe I would have considered some pit augmentation.

Although, honestly looking back, I probably wouldn't have agreed to pit at all, as my focus at that very moment was on getting THAT baby out of me safely, NOT on how I'd get some hypothetical, not-yet-conceived child somewhere in the future out of me.

But the fact that we never really even considered VBAC had a lot to do with the fact that we KNEW we'd be absolutely, 100% done having babies after number four at the very most, meaning three total sections, a number we were comfortable with.

[wifeandmom]

Originally Posted by trini

I have not read every post on this thread. I had a hard time reading about "dead babies" and "dead mommies." But thought I'd answer the question in the thread title.

After living through the death of our first son, I was willing to take on the "extra" risk that was quoted in your study. For me a repeat c-section was worth it emotionally and physically.

I know that many on here would disagree.

I hate writing it like that, as 'dead baby' is just so emotionally difficult to read, and I've never even experienced it myself. But I wasn't sure how else to word it, when the reality is, we are comparing how many deaths occur between the two choices.

I absolutely 100% agree that the 'extra' risk of maternal death is worth it when you consider the alternative, however I can also see the 'other' side because the numbers are very small either way. One is a bigger 'small' number, but small nonetheless.

What I cannot see is why I continue to read over and over again about how much 'safer' VBAC is compared to ERCS. That baffles me, cause it's simply NOT what the numbers show AT ALL.

[wifeandmom]

Originally Posted by aran

I was considering saying something about this, but I didn't have time to open up a long philosophical discussion. I would obviously take crazy risks for my DS and would die to protect him. But when I was pg with him, I didn't feel that way. It was only later, after he was born, and not even immediately. (I know I am not alone with this unfortunate feeling. Perhaps this is a biological mechanism to protect our species, which you might only believe, as I do, if you are a Darwinist.) Of course now, our bond is extremely close - to the point that strangers make comments about it - so I guess that less than picture perfect start was no problem. Anyhow, my point is that he didn't get the same level motherly emotional support from me in utero that he did once he was alive. Now that I have a DS and know what it's like to be a mother, maybe I will feel differently about a second child in utero. I can't say. Please - no flames - I hope I don't sound too callous - I really am not.

I think what you are describing here is PERFECTLY normal. It's not how *I* happened to feel about my own babies in utero, but that doesn't mean what *I* felt is the 'right' way, therefore making you 'wrong'. It is what it is, and it had a very large impact on my birthing choices, that is all.

FWIW, I am sticking with the vbac plans. I guess I won't discuss this with anyone IRL, because from the sound of it, I would probably come off sounding like a selfish jerk.

I think you come across as completely normal. Heck, I struggled with feelings of guilt over how much more 'dedicated' I felt to my twins while pg in comparison to my third child. What kind of mother was I to even HESITATE the second time around? But I'd look at my sweet babies' faces and think of them without a mother, and it was crushing.

That is NORMAL. How many women get pg the second time around and wonder how on earth they'll EVER love a second child as much as the first? I see that sentiment all.the.time. There is nothing wrong with feeling like that at all.

It does NOT make you selfish for choosing to do things differently. If you came on here and said 'Well, this baby is just going to have to come out vaginally or die, cause no way would I EVER consent to a c-section cause it's too risky for ME', then I'd have to wonder. But you aren't saying that at all. What I'm reading is that barring a real-life emergency, NOT just the *potential* for an emergency, you're going to go with VBAC. That is perfectly reasonable, especially considering you have looked at the numbers and you feel ok with your decision. That's really all any of us can do since we simply don't have a crystal ball.

[Phoebe]

Originally Posted by wifeandmom

We also KNOW that VBAC results in more dead babies than ERCS.

But does VBAC necessarily result in the demise of more babies than a vaginal birth with an unscarred uterus? Isn't a major uterine rupture the ONLY extra factor that would cause there to be more death in babies with a VBAC?

[GalateaDunkel]

Originally Posted by wifeandmom

my focus at that very moment was on getting THAT baby out of me safely, NOT on how I'd get some hypothetical, not-yet-conceived child somewhere in the future out of me.

Oh, I absolutely agree. But in the general question of VBAC vs. non-emergency cesarean, one complicating factor for me is that our desire for a large family is also based on moral/religious/philosophical beliefs, so it figures into moral reasoning more strongly than a simple emotional desire for more children would. This also feeds my interest in VBAC *as a movement* - while not expecting everyone to share my personal beliefs, I want to challenge the prevailing cultural assumption that limiting future childbearing is a totally unproblematic consequence of birth interventions.

[wifeandmom]

Originally Posted by Phoebe

But does VBAC necessarily result in the demise of more babies than a vaginal birth with an unscarred uterus? Isn't a major uterine rupture the ONLY extra factor that would cause there to be more death in babies with a VBAC?

I've never seen studies on that (or on how many babies die as a result of plain old vaginal birth), so I can't say for certain...

BUT I would have to guess that the answer would be YES, VBAC carries an overall higher risk of death for baby than vaginal birth with an unscarred uterus.

Why?

Cause with vaginal birth in the unscarred uterus, you're going to have babies die of fetal distress, shoulder distocia, abruption, etc etc etc. You are going to have FAR FEWER die of rupture though in the unscarred uterus simply because rupture in the unscarred uterus is so incredibly uncommon.

With VBAC, you're still going to have all of the risks of vaginal birth, PLUS the added risk of rupture related death.

Going back to the NEJM study, I'd have to guess that the deaths they reported were ONLY the ones directly attributed to rupture, as it seems the numbers would have to be higher if they were counting ALL dead babies during VBAC, but that is just a guess. Off to read more of the actual study results to see if they stated which is the case.

[Lkg4dmcrc]

Originally Posted by GalateaDunkel

Oh, I absolutely agree. But in the general question of VBAC vs. non-emergency cesarean, one complicating factor for me is that our desire for a large family is also based on moral/religious/philosophical beliefs, so it figures into moral reasoning more strongly than a simple emotional desire for more children would. This also feeds my interest in VBAC *as a movement* - while not expecting everyone to share my personal beliefs, I want to challenge the prevailing cultural assumption that limiting future childbearing is a totally unproblematic consequence of birth interventions.

I totally agree- without VBAC, doctors are basically dictating most women's family size. I want more than 2 and will take as many as I can have thus, I just am not comfortable with the 9% chance of a major complication (including hysterectomy) on a 3rd c-section. I am much more comfortable with the .2% chance of uterine rupture on my VBAC attempt than the stats of complications with the third cesarean. Others may not agree or are willing to assume these risks but that is where I am at.

[wifeandmom]

Originally Posted by Lkg4dmcrc

I totally agree- without VBAC, doctors are basically dictating most women's family size. I want more than 2 and will take as many as I can have thus, I just am not comfortable with the 9% chance of a major complication (including hysterectomy) on a 3rd c-section. I am much more comfortable with the .2% chance of uterine rupture on my VBAC attempt than the stats of complications with the third cesarean. Others may not agree or are willing to assume these risks but that is where I am at.

Where are you getting the 9% risk of major complication for a 3rd section? I'm truly curious, as I've never seen anything even remotely that high, not even for a fourth section.

Wait..never mind. I'm finding some stuff now that lumps a bunch of complications together for sections, most of which are NOT life threatening, yet still considered 'major' in terms of complications. So I see where the numbers might be coming from (although what I saw said 7.5% for 3rd section and 12.5% for 4th), but I wouldn't personally consider some of the 'major' complications to be 'major', as I reserve that particular term for things that might actually threaten my life.

[Storm Bride]

Originally Posted by wifeandmom

We also KNOW that VBAC ... results in more complications overall for mom, although mom is still more likely to die with ERCS.

Really? How do we "know" this? Because of studies? What do studies define as a complication? I had an infected incision with my third section - no rehospitalization, though. It might be in my FP's records, because she prescribed a topical antibiotic for me, but I doubt it's in my OB's records, and I'm sure it's not in my hospital records.

I'm 13 months pp, and can't feel my bladder. I don't know when I have to pee. I can't feel my abdomen from my navel to my scar. I've suffered from PPD and PTSD, but none of that is in my records, because I haven't seen a doctor for it. I know there are other women in the same boat. So, how do we "know" about complication rates?

[ericswifey27]

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