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Trying to make sense of uterine rupture fear... - Page 2

post #21 of 37
Thread Starter 
Quote:
Originally Posted by f&p'smama View Post
I personally take the risk of uterine rupture seriously. Yes, it's only .5% and if it were a .5% chance that my baby could end up brain damaged. I will VBAC this baby because I think it's less risky than a C-section for me and the baby, but I do take uterine rupture seriously.
I don't think anyone is saying they don't take the risk of UR seriously, just saying that it doesn't make sense that the more risky of the two options is being promoted as the "better" option. I could walk into any random OB right now and ask for a repeat c-section and could have one scheduled, no questions asked...but have to fight tooth and nail to find VBAC support, even though it is statistically the safer option for mother and baby.
post #22 of 37
Quote:
Originally Posted by f&p'smama View Post

I personally can't blame doctors for being protective of their livelihood. Yes, it would be great if every doctor did the "right" thing by every patient and didn't think of possible litigation, but the reality is that even if parents have been through true informed consent and the doctor is doing what they want, if something happens to the baby, they can be successfully sued. My OB was telling me that the average OB on the East Coast has been sued 1.3 times. Sometimes no one is doing something wrong and terrible things happen to babies. There are risks to having children.
I think that this is the problem-- in a lot of those cases, those primary c-sections were not for a valid medical reasons. So this is largely an OB- made problem. Honestly, if i died from having a repeat c-section or my baby died in a vbac, the responsibility would mainly lay in the fact that i couldn't find a doctor to be there to catch my frank breech first baby. Yes, it is risky to have a c-section. Yes, it is risky to have a vbac. Sometimes woman have a catastrophic rupture and sometimes they die during a RCS. If there weren't so many doctors doing frivolous primary c-sections in the first place, there wouldn't be the problem of having to choose between two risky things, kwim?
post #23 of 37
Quote:
Originally Posted by milkydoula View Post
If there weren't so many doctors doing frivolous primary c-sections in the first place, there wouldn't be the problem of having to choose between two risky things, kwim?


Amen to that!
post #24 of 37
Quote:
Originally Posted by Proverbs31 View Post
I don't think anyone is saying they don't take the risk of UR seriously, just saying that it doesn't make sense that the more risky of the two options is being promoted as the "better" option. I could walk into any random OB right now and ask for a repeat c-section and could have one scheduled, no questions asked...but have to fight tooth and nail to find VBAC support, even though it is statistically the safer option for mother and baby.
I didn't mean to imply that anyone wasn't taking it seriously -- just that for me personally, it does scare me. I agree -- it seems *most* people choose repeat C-section because they think it's safer, and it clearly is not in most cases. In my experience I am not having to fight for a VBAC, but I will have to fight for how I want to VBAC and it is very discouraging and irritating. : It sucks that in many parts of the country people have to fight just to VBAC. Someone on another board I'm on said in her area, they call it a "trial of labor" after a C-section. What a terrible way to word it -- it's like setting you up for failure before you even start. Even where I am where it's, in theory, pretty VBAC friendly, the only choices I am finding are home birth or hospital birth with restrictions -- no middle ground. More :
post #25 of 37
Quote:
Originally Posted by milkydoula View Post
I think that this is the problem-- in a lot of those cases, those primary c-sections were not for a valid medical reasons. So this is largely an OB- made problem. Honestly, if i died from having a repeat c-section or my baby died in a vbac, the responsibility would mainly lay in the fact that i couldn't find a doctor to be there to catch my frank breech first baby. Yes, it is risky to have a c-section. Yes, it is risky to have a vbac. Sometimes woman have a catastrophic rupture and sometimes they die during a RCS. If there weren't so many doctors doing frivolous primary c-sections in the first place, there wouldn't be the problem of having to choose between two risky things, kwim?
Yeah, I do KWYM. And I agree. But I also think part of the responsiblity lies in the litigious culture in the US. I think many OBs are terrified of a law suit and that drives their decision making, instead of what is best for this particular patient. That sucks and it's not right and it should not enter their decision making. Their oath is to first do no harm & if they're pushing surgery which is risker than a breech birth, it's wrong. There certainly are crappy doctors who push for a C-section because it's 7:30 on a Friday night and they want to get home. My Mom swears that her doc pushed Pitocin on her with my sister because he wanted to get to a golf game on a Saturday. I think many OBs are human and think about themselves and protecting their careers in addition to what's best for their patient. And I think there is some collective cultural responsibility for that. That's all I meant.

It's sad that things like breech birth are less and less a part of medical training and there are fewer and fewer OBs who even know how to do them. :
post #26 of 37
Quote:
Originally Posted by milkydoula View Post
If there weren't so many doctors doing frivolous primary c-sections in the first place, there wouldn't be the problem of having to choose between two risky things, kwim?
post #27 of 37
Quote:
Originally Posted by Proverbs31 View Post
I just picked up a copy of the new book "Pushed" by Jennifer Block; its awesome! Anyway, I'm up to the section about VBACs and the more I understand about uterine rupture, the more puzzled I am: I simply cannot make sense of why the obstetrics community (and women in general) take a c-section (and all of its' potential risks) so lightly...but quiver in fear at the extremely rare chance of uterine rupture???? When you get right down to it, isn't a c-section essentially a planned uterine rupture? Even my new midwife, while acknowledging how rare rupture is, says that its "something they worry about" with this ominous look on her face. Isn't normally the patient who has the irrational fear and the provider who reassures the patient with the facts? Something is just inherently backward about this whole thing: is there any other area of the medical community (plastic surgeons aside) where people are encouraged to undergo unnecessary surgery for something that will remedy itself with time?
It's about the lawsuits. If you have a catastrophic rupture and sue, you'll probably win because they didn't "do" something (ie the c/s) quickly enough.

What I'm dumbfounded by (and I haven't read all the replies so someone may have mentioned this already) is that the TOTAL risk of rupture is the same or lower than the likelihood that an amniocentesis will cause a miscarriage.....and only about 30% of ruptures are even catastrophic. Some are simply dehesciences (sp?), places where the scar pulls apart slightly with no harm to you or the baby. But amnio's are treated way more casually than VBAC, and I've never heard of a hospital "banning" amnio.
post #28 of 37
Quote:
Originally Posted by f&p'smama View Post
About home birth having fewer instances of uterine rupture, that may be true. But it may take a home birth midwife a long time to rack up 200 VBAC mamas, so just talking to one and asking if she's seen it, the answer is probably not.


ITA. I wish Homefirst, the home birth docs in Chicago, would publish their stats. They have 30 years and 14,000 births as a track record. I suspect that their rupture rate is the certainly no more than the statistical norm.
post #29 of 37
Quote:
Originally Posted by grumpyshoegirl View Post
What I'm dumbfounded by (and I haven't read all the replies so someone may have mentioned this already) is that the TOTAL risk of rupture is the same or lower than the likelihood that an amniocentesis will cause a miscarriage.....and only about 30% of ruptures are even catastrophic. Some are simply dehesciences (sp?), places where the scar pulls apart slightly with no harm to you or the baby. But amnio's are treated way more casually than VBAC, and I've never heard of a hospital "banning" amnio.
Good point!
post #30 of 37
With respect to the issue of lawsuits:

Canada is not known for having as litigious a culture as the US. Nonetheless, I see all the same justifications for c/s and RCS here as a I see in the US. I was still forced (as in prepped for surgery while screaming "no, I don't want a c-section", then given anesthetic without being told once I was in OR) into my first surgery, and my objections to my 2nd and 3rd were completely ignored. After 41w5d and over a week of prodomal labour, I was told that if I didn't have the surgery, I wouldn't have a doctor. C/S rates here are climbing. VBAC is hot topic, and while it's given lip service the first time around VBAmC is absolutely not allowed, and licensed midwives cannot attend them. The OB I was seeing the last two times (didn't have an OB for my first) informed me that we follow the US's lead. For example, ACOG apparently changed, or was considering changing, "post-date" guidelines to require induction or c/s at 41 weeks, whereas the Canadian guideline at the time was 41w, 3d. According to the OB, the SOGC (Society of Obstetricians and Gynecologist of Canada) will probably change their guidelines to the US ones.

So, even though the c/s rate and denial of VBAC is frequently laid at the door of the litigious US culture, and I frequently see universal health care cited as a cure...we have the same problem in Canada, despite having universal health care, and not having the same litigiousness of culture. There's more going on here than lawsuits. Is the problem as bad here? I don't think so - but it's still bad, and getting worse.
post #31 of 37
Quote:
Originally Posted by f&p'smama View Post
Yeah, I do KWYM. And I agree. But I also think part of the responsiblity lies in the litigious culture in the US. I think many OBs are terrified of a law suit and that drives their decision making, instead of what is best for this particular patient. That sucks and it's not right and it should not enter their decision making. Their oath is to first do no harm & if they're pushing surgery which is risker than a breech birth, it's wrong. There certainly are crappy doctors who push for a C-section because it's 7:30 on a Friday night and they want to get home. My Mom swears that her doc pushed Pitocin on her with my sister because he wanted to get to a golf game on a Saturday. I think many OBs are human and think about themselves and protecting their careers in addition to what's best for their patient. And I think there is some collective cultural responsibility for that. That's all I meant.

It's sad that things like breech birth are less and less a part of medical training and there are fewer and fewer OBs who even know how to do them. :
This is true. Women are more apt to sue if their baby isn't born perfectly healthy, even if it is no one's fault. Let's examine the roots of this. When doctors took birth into hospitals, there were promises of better infant mortality. But really, this was not the case, although women who could afford it gave into the illusion. But the doctors couldn't leave well enough alone. They had to improve on nature, they had to find a way to control the uncontrollable. They invented machines and procedures and gave drugs that would make birth more "scientific" under the guise of making it safer for babies. Why go through the pain of labor and have to push the baby out on your own when a doctor could knock you out, give you an episiotomy that would alter your genitals for the rest of your life and use forceps to rescue your baby from your body? The whole obstetrical system is based on the fact that women's bodies are flawed and our babies must be saved from them. And so big promises were made... if you give your flawed body to us, we make sure you have a healthy babies.

Women were set up for failure, especially as they started placing more and more strict guidelines on what was "normal" It only got worse when c-sections were made safer* Because this was the ultimate in controlling women's bodies. Only dialated to 5 after ten hours of labor? C-section! Baby is breech? C-section! 5'2" and 110lbs? Your baby must be too big for you to birth- C-section!

And thus the roots of why women are so ready to sue a doctor of something goes wrong. Because they promised us that if we gave ourselves over to them, knocked us out, cut our genitals, cut our bellies to save our babies from us and sacrificed our births that they could produce a healthy baby

*Please note, i am only talking about c-sections that are for not medically sound reasons. I thank God that c-sections were made safer for the women that truly do need them for themselves and for their babies
post #32 of 37
Quote:
Originally Posted by milkydoula View Post
And thus the roots of why women are so ready to sue a doctor of something goes wrong. Because they promised us that if we gave ourselves over to them, knocked us out, cut our genitals, cut our bellies to save our babies from us and sacrificed our births that they could produce a healthy baby
:
My doctors (family physician and OB) never once said "you and your baby will be healthy if you have this section, and you won't be if you don't", but the message was carried in everything they said to me for months...right down to my FP's emotional blackmail about how she couldn't sleep at night because she was so worried about me (because I was insisting on VBA2Cing) and the never-ending mantra of "you're making a mistake - I wouldn't do this - we want a healthy mom and a healthy baby". I still managed to stick to my guns until the final ultimatum, but the pressure was unbelievable...and there was an implied promise there.
post #33 of 37
Interesting thread. There is absolutely no way in the world I'd have an amniocentesis because I would never accept a 1 in 200 risk of miscarriage as acceptable. If my baby had a 1 in 200 chance of dying from VBAC I'd have a c-section in a heartbeat. But the risk to the baby is obviously much less than this making an uncomplicated VBAC the safest mode of delivery for my baby.

What I want from this pregnancy is a living baby and a living mama and I'm quite comfortable with operative intervention to achieve this if necessary. I had a csection due to severe HELLP syndrome and without the interventions we had my son and I would both be dead. At the time I did feel betrayed. I truly trusted that my body could grow and birth a baby and in fact it couldn't do it without putting both of us is lifethreatening danger.

Now I trust my body to do the best that it can and I am so thankful that I live in a time when if I get one of the lifethreatening diseases associated with pregnancy again it is likely that my child and I will be able to survive it, unlike legions of women and babies over the centuries before this one. Even twenty years ago my cousins died in similar circumstances (birth at 28 weeks) to those which my son has survived and thrived following.

Unnecessary csection does endanger women and babies, along with unnecessary amnio and so many other interventions. As a medical practitioner I counsel women to avoid all such unnecessary interventions.

Anna mum to Bede 7 and Emmett 3.5 partner to LEah for 10 years
post #34 of 37
I don't think you'll find a mama here who thinks that all c/s are unnecessary. There are, however, many mothers here who have had unnecessary surgery the first time, and then subjected to even more unnecessary surgery because of the first one. It just makes us : trying to understand why. If we can see through it and understand VBAC is as low risk as birth with an unscarred uterus, then why can't the obstetrical community?

I'm glad to hear there are medical practitioners advising against unnecessary interventions. We need more advocates like that in obstetrics.
post #35 of 37
Quote:
Originally Posted by TanyaS View Post
If we can see through it and understand VBAC is as low risk as birth with an unscarred uterus, then why can't the obstetrical community?
But it's *not* as low risk as birth with an unscarred uterus.

Rupture rates for VBAC are drastically different than rupture rates in the unscarred uterus. 1 in 15,000 is not even comparable to 1 in 200. It just isn't.

That doesn't mean that 1 in 200 is too risky to consider, but to suggest that laboring with a scarred uterus is 'as low risk' as laboring with an unscarred one simply is not true.
post #36 of 37
Sorry. That's what I get for posting late at night.

What I meant with my post is that the UR risk associated with VBAC is not any riskier than the other things that can go wrong with vaginal birth sans scar (i.e. cord prolapse, etc). Some things associated with pregnancy even have a higher rate of incidence than UR.
post #37 of 37
Quote:
Originally Posted by wifeandmom View Post
Rupture rates for VBAC are drastically different than rupture rates in the unscarred uterus. 1 in 15,000 is not even comparable to 1 in 200. It just isn't.
But the other thing to note here is that in labor is not the only time a woman with a prior c/s can experience ur. What TanyaS is probably referring to is the fact that most docs tend to ignore that fact. They put all the risk on moms who want a VBAC and ignore the fact that ur can happen ANY time in a pregnancy. Just thinking that one can automatically avoid the ur risk if they go with a repeat c/s is simply not true.

Of course...part of that assumption for "high risk" when it comes to ur also has a lot to do with obstetrical "management" of labor...but that's a whole 'nother post.
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