1 in 200 is not a small risk - Page 2 - Mothering Forums
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#31 of 41 Old 10-04-2005, 06:20 PM
 
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Quote:
Originally Posted by Mama to 4
Does anyone have any stats on your chances of successful VBAC if you have already had one successful VBAC?

I had vaginal birth 1997
C-sec 2000
VBAC at home 2003
Due to try another VBAC at home 2 weeks from now

I dont know if this is OT, I just was getting into all the stats!
I don't know the stats but definitely your chances of success go up and your chances of uterine rupture go down, both by significant margins.
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#32 of 41 Old 10-04-2005, 07:16 PM
 
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I have been researching my risk of dying from a blood clot in a new pregnancy (after threats of this from medical folk lately) and have been reading succesive reports porduced in the UK collating reasons for maternal death. Apparently, the UK is one of the few countries which actually logs maternal death and distributes the findings to health care providers. All the midwives I have spoken to are aware of the triennial reports.

It contains a page discussing uterine rupture and the fact that it was much more common in the past. In the past 3 years it appears that no mothers have died from it.

http://www.cemach.org.uk/publication...002/wmd-08.htm

I know that you are probably more concerned about your child's chances in the event of a rupture more than your own, but we forget that we are mortal too.

I think that the data are reliable but I do have one caveat; medicalisation of birth has not reached such drastic levels over here so the data may be less applicable to your circumstances if you are in a more managed situation.

My heart goes out to those of you who know that doing everything 'right' is still no guarantee.
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#33 of 41 Old 10-05-2005, 12:23 PM
 
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Bohomama, the online article doesn't list the baselines, so there is really no way to see if you fall into those categories. Most researchers will send you a reprint of the actual published article for free though. And that most certainly will have the baselines listed.

Beth, I've read your posts over the past couple of months over and over and am so sorry for your loss. They have really, really made me think about my decision to VBAC.

It always boils down to me though that I have a 4 year old to think about as well. So the risk for maternal death during a scheduled c-section is almost double the risk of uterine ruputure. Worst case scenarios - I end up running around the choice of having 2 motherless children or an infant who dies but one child with a mother. And considering the risk of 2 motherless children (scheduled cesarean) is almost double that of an infant who dies (VBAC with uterine rupture), then I always end up choosing VBAC.

It's almost an impossible choice to make, especially since I have never had an infant die so have no idea of the emotional impact of that other than reading others' accounts.
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#34 of 41 Old 10-05-2005, 02:34 PM
 
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Is the risk of maternal death during a c/s really TWICE as high as risk for uterine rupture? I had always read that maternal death was very rare, twice as likely with a c/s, but still extremely rare. More common in emergency sections than in planned ones.

I found this just now:
"Maternal death (very rare). The overall risk of death for women who have a planned cesarean delivery is very low (less than 3 in 100,000). Most cesarean-related deaths are after emergency deliveries (30 in 100,000).1" Here`s the link, feel free to challenge it with a better link, its all I could find, http://www.questdiagnostics.com/kbas...n8162/sec6.htm


I know that there is some disagreement here that 1 in 100 is not indicative of severe uterine ruptures, still it looks like comparing u/r to c/s death of mom is not apples to apples.

Beth, I also have read everything you`ve written here and I feel for you so much. I want you to know you are not alone in researching the cause of your daughter`s death. I lost my son to severe shoulder dystocia in a hb, also doing "everything right." I still read about shoulder dystocia sometimes now. I also feel that most births are safe, even vbacs and hb`s with known-to-be-big babies, I also have a hard time encouraging these things, mostly I stay out of it. The chances are small of a disastrous outcome. I think the chance of a fatal shoulder dystocia is something like 1 in 30,000. Well, when it happens to you the chance is 100% so it means nothing. I `m not trying to take over and talk about me, I don`t even know what I`m trying to say exactly, jut that I`m glad you wrote what you did.

Married Catholic mami : to 5 boys, : 9 6 3 : 5 mo. 5/6/02-6/22/02 (HIE)
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#35 of 41 Old 10-05-2005, 02:52 PM
 
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I don't like reading UR stats, because they're not really relevant. The way I see it, each woman, in each delivery, has either a 100% chance or a 0% chance of rupture. I wish to hell we had a way to know which applies to any given woman...

Beth: Like others here, I've been reading your posts, and I don't have the words to say how sorry I am. Nobody ever likes to think about the possibility that they could lose a baby, but we all know that it does happen.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#36 of 41 Old 10-05-2005, 05:28 PM
 
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I was going off of the famous study in the NEJM published last year. The way I understand it, 2 (.01%) of babies died from a UR. But there were 7 (.04%) maternal deaths resulting from cesarean surgery. Here's the link to the article by David Dobbs (very well written and clear explanation IMO)

http://slate.msn.com/id/2111499/

And that actually means that risk from a cesareans is even more than double. But double is what stuck in my mind!
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#37 of 41 Old 10-05-2005, 08:00 PM
 
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Wow! That is pretty shocking Girrllie. My link must be older than that most recent study. If you think about it though, the rate of any uterine rupture at all was much higher than death to mom by c/s. .7 vs. .04. Most moms do have more minor u/r (out of the ones that do rupture) and the truly tragic ones are still rare, but its hard to know which will happen.

Married Catholic mami : to 5 boys, : 9 6 3 : 5 mo. 5/6/02-6/22/02 (HIE)
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#38 of 41 Old 10-05-2005, 09:44 PM
 
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Quote:
Originally Posted by girrllie
And that actually means that risk from a cesareans is even more than double. But double is what stuck in my mind!
I think it depends on what you're comparing honestly. In that study, in the TOL group, 2 babies died and 7 had HIE (essentially brain dead or extremely limited brain function). In the ERCS group, there were 0 cases of HIE. In the TOL group, there were 3 maternal deaths. In the ERCS group there were 7 maternal deaths.

While only 2 babies died, many HIE children have extremely low or no quality of life. Technically, my baby did not die from my VBAC attempt. She had HIE. Which in our case meant no brain function, her pupils were fixed and dilated from birth, and we basically had to make the decision when to take her off the ventilator. You can read about HIE here:

http://www.emedicine.com/ped/topic149.htm

My take away from the NEJM study (both before my VBAC attempt and now) is that ERCS and TOL are basically equivalent in terms of safety. At the time, I too thought that the tradeoff on risk for maternal death (and other things) was worth the VBAC attempt. Of course, in retrospect, I am not so clear on that decision. I am happy to be alive, but there is guilt I will carry with me the rest of my life.

I would encourage everyone to read the NEJM article for themselves rather than relying on interpretation from others. It has very clear charts and is well written IMO. You can access the article at the NEJM website. Since the article is more than 6 months old, you can register and read it for free.

http://content.nejm.org/content/vol3...25/index.shtml

New WOHM to DD8 and DD3
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#39 of 41 Old 10-05-2005, 09:54 PM
 
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Originally Posted by girrllie
I was going off of the famous study in the NEJM published last year. The way I understand it, 2 (.01%) of babies died from a UR. But there were 7 (.04%) maternal deaths resulting from cesarean surgery. Here's the link to the article by David Dobbs (very well written and clear explanation IMO)

http://slate.msn.com/id/2111499/

And that actually means that risk from a cesareans is even more than double. But double is what stuck in my mind!

Which brings us to the real problem, too many unneccessary c-sections.
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#40 of 41 Old 10-05-2005, 10:15 PM
 
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"While only 2 babies died, many HIE children have extremely low or no quality of life. Technically, my baby did not die from my VBAC attempt. She had HIE. Which in our case meant no brain function, her pupils were fixed and dilated from birth, and we basically had to make the decision when to take her off the ventilator" -egoldber

This is an excellent point. I also noticed this when I read the study. Our son lived for 7 weeks with HIE. Most babies who suffer a severe brain injury at birth live to be 3 years old at the oldest (on average). The study didn`t follow the other babies.

Married Catholic mami : to 5 boys, : 9 6 3 : 5 mo. 5/6/02-6/22/02 (HIE)
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#41 of 41 Old 10-06-2005, 12:29 AM
 
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Yes, the statistics really don't tell you much other than that there are risks on both sides. Like how do you really compare maternal death to infant death to HIE? How do you really compare someone's actual grief to someone's potential for grief? Especially without getting freaked out (at least for me) and very emotional just thinking about it? Sometimes I think it just comes down to making a decision - any decision and feeling o.k., at least in the meantime, living with that decision.

I have a friend who had 3 beautiful, natural births (2 HBs) with 3 healthy children. And she spent her third pregnancy convinced, worried, and distressed that something horrible would happen - breaking down in tears frequently. For me, I can't live like that. It's like I have to hope for the best, while acknowledging that horrible things may happen, whether I plan for a VBAC or plan for a cesarean.

I'm not trying to discount anyone's experiences, truly. My decision boils down to which decision can I be less stressed about in the meantime. Which one can I wrap my brain around the best? Which one makes my stomach turn or which one make me feel more hopeful and peaceful? Which one could I live with if something catastrophic happened? For me, it's VBAC. For someone else, they feel safer with a scheduled cesarean, which is o.k. too. We can go around and around about statistics, but I think it just depends on the mom and their comfort level more than the actual statistics.
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