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

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#31 of 59 Old 09-03-2006, 05:21 PM
 
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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.

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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.
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#32 of 59 Old 09-03-2006, 05:24 PM
 
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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.
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#33 of 59 Old 09-03-2006, 05:32 PM
 
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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.


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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.
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#34 of 59 Old 09-03-2006, 06:24 PM
 
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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?

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#35 of 59 Old 09-03-2006, 06:37 PM
 
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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.
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#36 of 59 Old 09-03-2006, 06:44 PM
 
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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.
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#37 of 59 Old 09-03-2006, 06:45 PM
 
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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.
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#38 of 59 Old 09-03-2006, 07:03 PM
 
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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.
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#39 of 59 Old 09-03-2006, 08:22 PM
 
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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?

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#40 of 59 Old 09-03-2006, 08:28 PM
 
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subbing...

Mama to my spirited J, and L, my homebirth: baby especially DTaP, MMR (family vax injuries)
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#41 of 59 Old 09-03-2006, 08:30 PM - Thread Starter
 
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Originally Posted by Storm Bride
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?
s to you and very well asked!
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#42 of 59 Old 09-03-2006, 08:32 PM
 
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Originally Posted by wifeandmom
..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.
Ahh...that explains some of our radically different way of looking at this issue. I reserve it for anything that significantly damages my quality of life. I actually consider a big, bloody, infected gash across my abdomen to be a "complication", but of course doctors don't look at it that way.

Anyway - everything you've said about the dangers of VBAC just makes me feel the way I always have. C-sections kill babies. You and the doctors don't count the ones who died in VBAC attempts as c-section deaths. I do.

I don't know if you mentioned this point or not, but where do babies who die of a rupture or whatever before the "due date" or surgery date fit in?

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#43 of 59 Old 09-03-2006, 08:32 PM - Thread Starter
 
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Originally Posted by wifeandmom
We also KNOW that VBAC results in more dead babies than ERCS.
I cannot exactly agree with this... "we" do not "know" this.. me being the we.. I have had 4 VBACs and only one c/s... my c/s is the only one of my babies that were acutally born blue. The only one of my pregnancies that ended in problems.
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#44 of 59 Old 09-03-2006, 08:34 PM
 
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Originally Posted by Lkg4dmcrc
I totally agree- without VBAC, doctors are basically dictating most women's family size.
My mom wanted six kids. She got three.

Mind you, I've only got three, and probably won't get the fourth one that I want...but at least in my case, the limit wasn't handed down by some OB...

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#45 of 59 Old 09-03-2006, 08:46 PM
 
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I've had 3 c sections. No, they are not fun, & easy to deal with (not to me anyway). My son, my first...I went through about 18 hrs of labor...tried having him vaginally with no progress. I couldn't. The shape of my pelvis would not accomodate his head and may not for future babies. Had an emergency c section. Because of my history and scar my doctor felt it best to have a repeat scheduled. So my daughter, second child, Aja was born via c section also.

There are serious risks involved with ANY major surgery. I lost my last , Alexis, just 3 months ago...to what? Uterine rupture. Thats the price for not being able to give birth vaginally...it sucks. So, no, you are NEVER 100% safe no matter what you choose...pregnancy itself, while natural, can be dangerous depending on the person and their situation.

As for people electing c sections "just because"...its not my place to judge other peoples decisions on how to have babies. People "elect" to have lipo when they're too lazy to exercise their way to health, people "elect" to have nose jobs and every other thing done. Do I care? not really, its their business. I personally would never elect a c section if I could have babies vaginally w/o complications. Shorter recovery, less risk for infection and less risk for mom and baby. I really do admire the moms on here who do home births and unassisted births and also the moms who go without meds. Cheers to you. I'd give anything to be in your place and not have to deal with the risks c sections bring along. I'm seeing alot of threads that say "Cesarean/Death" in the same sentence...trust me, I know. I do not go into the operating room worry free. I tremble each and every time I go through this in fear of something going wrong. But prayer keeps me going and I know in the end, if its my time, its my time. We are ttc #4...and yes, a scheduled cesarean will take place. I will be high risk & seeing a MFM because this would be my 4th, I had a stillbirth and the causes of her death...but TO ME, its all worth it. Good day yall.

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#46 of 59 Old 09-03-2006, 09:30 PM
 
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momz3,
I am so sorry to hear about your daughter.
I wouldn't blame you one bit for choosing a csection for your 4th. Frankly, I wouldn't blame anyone for not choosing VBAC. I myself am choosing VBAC for my 2nd child due in November. I will plug ahead with confidence but it surely brings me back to earth hearing your story. Thanks for sharing it with us. I know it must be painful.

Amy

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#47 of 59 Old 09-03-2006, 10:51 PM
 
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Originally Posted by Storm Bride
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?

I would venture to guess that ANY study that doesn't come to a conclusion that you agree with would be flawed in some way, but that's just a guess.

How do we KNOW that vaginal birth is preferable to elective section? If every study is 'flawed' somehow, if there is no possible way to trust the results of a study because they might have missed something somewhere along the way, how exactly can you say with any certainty which choice is the safer of the two?

Personally, if the NEJM prints something, it is pretty solid. And if you don't trust the NEJM, what DO you trust in terms of printed research?
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#48 of 59 Old 09-03-2006, 10:55 PM
 
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Originally Posted by Tummy
I cannot exactly agree with this... "we" do not "know" this.. me being the we.. I have had 4 VBACs and only one c/s... my c/s is the only one of my babies that were acutally born blue. The only one of my pregnancies that ended in problems.
And that would be what is called anecdotal evidence, which is worth exactly squat in a real research study. For a reason.

I had two c-sections with no complications whatsoever. That does not mean that I go around touting them as completely safe, without risk of complications, simply because that happens to be MY experience.
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#49 of 59 Old 09-03-2006, 10:59 PM - Thread Starter
 
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Originally Posted by wifeandmom
That does not mean that I go around touting them as completely safe, without risk of complications, simply because that happens to be MY experience.
Was that direceted at me?
If so, I do not believe that I have been touting anything to be anything.

Just trying to clarify here. Thanks
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#50 of 59 Old 09-03-2006, 11:02 PM
 
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Originally Posted by Storm Bride
I actually consider a big, bloody, infected gash across my abdomen to be a "complication", but of course doctors don't look at it that way.
Would this be the same infection your doctor treated with a topical antibiotic cream? If so, then I'd find it highly unlikely that such an infection would be considered a 'major' complication of having a c-section.

Major infection complications are more along the lines of needing IV antibiotics, or at least oral antibiotics. Something that can be dealt with using a TOPICAL antibiotic would fall far short of any medical definition of 'major complication' if I had to guess.


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I don't know if you mentioned this point or not, but where do babies who die of a rupture or whatever before the "due date" or surgery date fit in?
It depends on what they died of.

My understanding of the way the NEJM study was set up is that babies who died PRIOR to labor and/or scheduled surgery date were dealt with completely separate with some discussion of babies who were stillborn past 39 weeks that were in the planned VBAC group since the assumption is those babies would have likely been delivered alive and well had mom been in the ERCS group.

For example, if a baby was stillborn at 41 weeks of a cord accident, it could reasonably be assumed that said baby would have survived in the ERCS group, since said baby would have been delivered around 39 weeks, thus not even being in utero at the time he/she actually died.

All of those babies, however, were in a completely separate listing on the tables in the study. Only the babies that were actually alive at the time of either VBAC attempt or ERCS were counted in the numbers I listed earlier. Even then, it was taken into consideration if baby had some sort of congenital problem that would have led to death regardless of delivery method.
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#51 of 59 Old 09-03-2006, 11:08 PM
 
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Originally Posted by Tummy
Was that direceted at me?
If so, I do not believe that I have been touting anything to be anything.

Just trying to clarify here. Thanks
I suppose I am confused then.

In one statement you say that you don't believe the statistical research that indicates VBAC results in more complications overall based solely on your own personal experience, but now you're saying what?

Do you, or do you not, believe the study results from the NEJM article to be valid? Accurate? Rubbish? What exactly?

And if your opinion on these results is strictly based on your own personal experience, do you realize that this is simply not how sound research works?

It seemed to me that your assertation was VBAC was obviously safer based on your own experience...which is simply not how one goes about determining which is TRULY safer.
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#52 of 59 Old 09-03-2006, 11:36 PM
 
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momz3 - I agree with everything you said.

wifeandmom - thank you for continuing to bring accuracy & research back into this thread.

Neither, VBAC's nor C-Sec are risk free. For myself, it is the risk to benefit aspect. I have a higher risk of a complication in a VBAC than a C-sec, so I would choose a C-sec. But that is me. I am not willing to take any more risks. Each mother needs to make the decision on her own (even though it is harder to make that choice.)

Cristina - "If you find it in your heart to care for somebody else, you will have succeeded." Maya Angelou
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#53 of 59 Old 09-03-2006, 11:41 PM
 
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Originally Posted by wifeandmom
Would this be the same infection your doctor treated with a topical antibiotic cream? If so, then I'd find it highly unlikely that such an infection would be considered a 'major' complication of having a c-section.

Major infection complications are more along the lines of needing IV antibiotics, or at least oral antibiotics. Something that can be dealt with using a TOPICAL antibiotic would fall far short of any medical definition of 'major complication' if I had to guess.
I agree. I'm sure the doctors don't consider it a major complication if you're not re-hospitalized and your dh can administer the necessary treatment. I didn't say that it was a "major" complication. However, if I'd ever believed the crap about how wonderful c-sections were, I'd have been fairly angry when I discovered that my doctors didn't consider the infection to be a complication at all.

In any case, the infection is kind of a red herring. My point was that I consider a great, painful, bloody gash across my abdomen to be a complication. Of course it's not - it's simply the inevitable result of being sliced open violently.


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It depends on what they died of.

My understanding of the way the NEJM study was set up is that babies who died PRIOR to labor and/or scheduled surgery date were dealt with completely separate with some discussion of babies who were stillborn past 39 weeks that were in the planned VBAC group since the assumption is those babies would have likely been delivered alive and well had mom been in the ERCS group.

For example, if a baby was stillborn at 41 weeks of a cord accident, it could reasonably be assumed that said baby would have survived in the ERCS group, since said baby would have been delivered around 39 weeks, thus not even being in utero at the time he/she actually died.

All of those babies, however, were in a completely separate listing on the tables in the study. Only the babies that were actually alive at the time of either VBAC attempt or ERCS were counted in the numbers I listed earlier. Even then, it was taken into consideration if baby had some sort of congenital problem that would have led to death regardless of delivery method.
Thanks for the clarification.

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#54 of 59 Old 09-03-2006, 11:49 PM
 
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Originally Posted by wifeandmom
I would venture to guess that ANY study that doesn't come to a conclusion that you agree with would be flawed in some way, but that's just a guess.

How do we KNOW that vaginal birth is preferable to elective section? If every study is 'flawed' somehow, if there is no possible way to trust the results of a study because they might have missed something somewhere along the way, how exactly can you say with any certainty which choice is the safer of the two?

Personally, if the NEJM prints something, it is pretty solid. And if you don't trust the NEJM, what DO you trust in terms of printed research?
I think every study on either side is flawed. The issues are too complex.

C-sections are not safe for me - the psychological toll is far too high. (If I actually did slit my wrists, that wouldn't count as a complication, either - but it would be directly related to my sections.) I don't really care if studies show higher risk of PPD in c-section moms or vaginal birth moms...I don't care what the PTSD risk is in the general population. I know what sections do to me on a psychological level. I know what they do to me. Anecdotal evidence is useless in determining statistics...but it does provide information about where to research, and it definitely is useful where the individual is concerned.

Incidentally, my doctor told me that the fact that my primary scar was a decade old when I had my next section made no difference, because "a scar is a scar". Funny - all the research I did showed that older scars are statistically less likely to rupture. Admittedly, I haven't seen any research on women like me, as I don't think a 10-year gap between first term pregnancy and second term pregnancy is very common. But, a longer gap between pregnancies is associated with a lower rupture rate. I knew that - my doctor didn't. So, my doctor not only didn't know anything about how a section would affect me personally - she wasn't even as well informed as I was about some of the research.

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#55 of 59 Old 09-04-2006, 12:35 AM
 
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Originally Posted by Storm Bride

Incidentally, my doctor told me that the fact that my primary scar was a decade old when I had my next section made no difference, because "a scar is a scar". Funny - all the research I did showed that older scars are statistically less likely to rupture. Admittedly, I haven't seen any research on women like me, as I don't think a 10-year gap between first term pregnancy and second term pregnancy is very common. But, a longer gap between pregnancies is associated with a lower rupture rate. I knew that - my doctor didn't. So, my doctor not only didn't know anything about how a section would affect me personally - she wasn't even as well informed as I was about some of the research.
Going from the birth dates in your signature, it certainly WAS common knowledge that section to VBAC intervals of less than 18 months increased rupture risk. Had it been me, I'd have printed off the exact research studies and asked for an explanation between what you were being told and what was printed at that time. It's exactly what I did with my peris, they hated it, but they sure got over it.
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#56 of 59 Old 09-04-2006, 02:55 AM
 
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I didn't bother, because it was my FP. My OB knew that the length of time between ds1 and dd reduced my risk. Even ds2 was just over 2 years from when dd arrived. If I do have another, it will definitely be a 2+ year interval again. (I'd rather not wait that long at my age, but that's just the way it is.) When I disagreed with my OB, I did take in research - my FP was deferring to his judgment, in any case.

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#57 of 59 Old 09-04-2006, 10:25 AM
 
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Originally Posted by wifeandmom
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.
These numbers were taken from the Landon et al(NEJM) study. I have read this study about 20 times since it was published and used it as part of my graduate coursework and thesis on this topic. It is devastating anytime there is a death of a mom or baby. I am in no way trying to make light of these loss but pointing out based on research what these numbers mean.

The study stated that in the maternal mortality category there was 3 women in the VBAC group and 7 in the RCS group. However the study states there is NOT a statistically significant difference between the numbers. However, it was even more interesting to look at the cause of death for these women. In the VBAC group, one woman died of severe preeclampsia with hepatic(liver) failure, one with sickle cell crisis with cardiac arrest, and one with postpartum hemorrhage. Two of the 3 did go on to have a c/s however it did not state which women. The striking thing to me as a researcher is that 2 of these women were even included in the study as most studies exclude women with severe preexisting life-threatening conditions, including the study which started this thread. In the RCS group, the study stated several times that 2 of the 7 deaths were directly attributed the the c/s itself-hemorrhage and anesthesia complications. There were 4 women who died of suspected amniotic fluid embolism. The other women died of an aortic dissection, which depending on the cause could also be considered a preexisting life threatening condition. The number of suspected amniotic fluid embolisms stood out to me. Why? This condition is a sudden event with a very high mortality rate which unlike most other complications does not have a treatment. There were 15801 women in the ECS group with 4 events. The accepted medical incidence of amniotic fluid embolism is 1:20,000-80,000. For a study population of this size there should have been none to maybe 1 statistically. There fact that there was 4 is extremely disturbing and definitely should be investigated further.

Now for the neonatal mortality category. There were 13 infants in the VBAC group and 7 infants in the RCS group. Again the study stated the there was NO STATISTICALLY SIGNIFICANT DIFFERENCE between the two groups. The other category was HIE(brain damage). There were actually 12 infants in this category, 2 of which are also included in the mortality group. In looking at the data, 4 occurred after the mother was induced and 2 occurred after augmentation. There were 7 that occurred after uterine rupture(significant overlap with induction/augmentation). The study also states that the remaining 5 (of 15177 TOLs) that occurred that did not involved uterine rupture was consistent with the medically accepted incidence for both TOL and scheduled RCS.

I tihnk that it is also important to know that this study was NOT based only on women with one prior LTCS at term. This study included women with 1,2,3 and more previous cesarean including in the VBAC group. All women who were at greater than 20 weeks were included. This included 14.1% in the VBAC group and 5% in the RCS group that were preterm(<37 weeks). The study did not state how many deaths/HIE were due to prematurity. In the VBAC group, 3.3% were under 1500 grams and 7.4% were b/w 1501 and 2499 grams while in the RCS group 0.2% were under 1500 grams and 2.7% were b/w 1501 and 2499 grams. There were women included in the study and the rupture rates that had previous classical, low vertical, inverted T, J and unknown incisions also. The use of induction and augmentation medications(pitocin and prostaglandins) were also heavily used. The uterine rupture rate was 0.4% for spontaneous labor, 0.9% for augmented labor and 1% for induced labor.
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#58 of 59 Old 09-04-2006, 10:44 AM
 
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Originally Posted by wifeandmom

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.
NO, actually the numbers they reported were for ALL neonatal deaths in both the VBAC and RCS groups. There were a total of 2 neonatal deaths after uterine rupture in 17,898 TOL. There were 2 deaths from HIE stated in the study. The remaining neonatal deaths in both categories were not explained however there was mention of congenital anomalies however the study did not state how many and which groups that involved. I would be interested in finding out how many were due to prematurity and RDS.
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