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Old 06-22-2007, 12:54 PM
 
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I feel no obligation to be truthful or honor bound with any OB or any doctor anywhere, to be quite honest. As a PP said, taking risks or not in birth is MY choice, and should be MY final say, not some random person or persons that I will probably never see again.

I tell people what I think will get me the best outcome possible. I don't really care if they like it or believe it. But I'm quite jaded. I am in that "encouraged to have a VBAC until it was too late to find another provider" category. I ended up preparing for an unassisted birth in about my 7th month, because it was only then that my "very nice" provider suddenly decided that I had no choice but to schedule a cesarean due to having a prior cesarean.

Perhaps its just a side effect of being an unassisted birther and knowing the horror stories that come with giving too much information. I don't know. But what I do know is that trusting doctors and midwives without knowing their track record is asking for trouble on so many levels. My last OB/CNM group seemed great... phenominal... reccomended by MANY local women. They were great too, until they realized that I was not going to be a good little sheep and do what I was told. (there was not a single discussion during my entire pregnancy about choosing tests/proceedures - it was all just done to me) Its hard to see the true colors of others until crunch time, and thats not the time that I can handle learning that my "great doctor/midwife" is not so great after all.

All that being said, I actually went out on a limb and told my current CNM that I had an unassisted birth last time, and why (because my OB/CNM practice flat out refused to even discuss a vaginal birth with me). I did it because I was encouraged to by a local direct entry midwife that I hold in very high regard, and because she felt that letting people know my situation might help the cause of allowing midwives to do VBACs again (its currently illegal in SC for homebirth midwives to do VBACs)

I am planning an unassisted birth again, but I am not telling anyone that. So I guess I'm lying again. Its self preservation, which is more important than the truth, in my opinion. I don't trust people who don't share my views to take that truth and hold it to them, and not try to change/ruin my child's birth to their own end. I know that I could have very easily been one of those that was forced by legal intervention to have a cesarean. My OBs felt that strongly about it. That just does not bode well for women, that we can be forced to do something so unnecessary by people who have no vested interest. If it takes lying to avoid that... so be it.
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Old 06-22-2007, 03:03 PM
 
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In the NEJM study, they only counted catastrophic ruptures, not dehiscenses or 'windows' noted at delivery. They actually gave stats on dehiscenses in that study as well, though I can't remember what they were.
The 2004 study looked at "symptomatic rupture" (the study author's words) not catastrophic rupture. The rate of hypoxic-encepholopathy including death in those infants was 0.45 per 1000, or a little less than 1 in 2000. This study used direct hospital record reviews, and called physicians to clarify if they couldn't figure it out from the chart.


I think it's highly unfortunate that we are living in a time where women would feel that they can't get evidence based care or have the ability to make their own decisions and feel they might have to lie to get the kind of care they want.
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Old 06-22-2007, 03:44 PM
 
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The 2004 NEJM article is basically the same information that Landon et al. presented in Obstetrics and Gynecology in July 2006.

It should be noted that the NEJM study includes women attempting vbac after 1, 2 or 3 or more c-sections. All those stats on rupture are not simply for a vba1c attempt. The 2006 study separates that out. The 2004 NEJM study also includes women with vertical incisions, though that didn't seem to affect the overall rate of rupture (but those results were separated out to show the increased risks with non-low transverse scars).

Some of the women induced had misoprostol which should not be used for ANY woman.


I also didn't see the 2004 NEJM study separate out the rupture rates for women less than 2 years from their c-sections. The 2006 study mentioned that about a quarter of the women in the study were less than 2 years from their c-sections which also increases risk slightly (1.1%)

I think the bottom line is that there is so much data and many unique circumstances in a study like this. For instance, how many women were induced and less than 2 years from their c-section delivery? How many women were induced on a vba2c attempt? Which would have more of an effect? It's hard to figure out exactly what the risk is for a particular vbac, especially when there may be multiple risk factors.




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Originally Posted by E'smom View Post
Also, the statistic for 1 in 15,000 ruptures in unscarred uteruses might be a bit generous. From a summary that I bookmarked a while ago, it appears that 1 in 15,000 is correct for women who have normal vaginal deliveries. The number might be as low as 1 in 802 in women who had a failed trial of labor followed by a primary csection. Obviously, these women were unscarred going into labor. http://www.emedicine.com/med/topic3746.htm This is a summary of a lot of articles and they combine studies so it’s a lot to interpret and go through
Thanks for that link! I knew rupture in unscarred uteruses wasn't that rare!

Proud mommy 9/2004 ribboncesarean.gif , 11/2007 vbac.gif, 2/2011 ribboncesarean.gif
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Old 06-22-2007, 07:07 PM
 
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Originally Posted by dlm194 View Post
The 2004 NEJM article is basically the same information that Landon et al. presented in Obstetrics and Gynecology in July 2006.

It should be noted that the NEJM study includes women attempting vbac after 1, 2 or 3 or more c-sections. All those stats on rupture are not simply for a vba1c attempt. The 2006 study separates that out. The 2004 NEJM study also includes women with vertical incisions, though that didn't seem to affect the overall rate of rupture (but those results were separated out to show the increased risks with non-low transverse scars).

Some of the women induced had misoprostol which should not be used for ANY woman.


I also didn't see the 2004 NEJM study separate out the rupture rates for women less than 2 years from their c-sections. The 2006 study mentioned that about a quarter of the women in the study were less than 2 years from their c-sections which also increases risk slightly (1.1%)

I think the bottom line is that there is so much data and many unique circumstances in a study like this. For instance, how many women were induced and less than 2 years from their c-section delivery? How many women were induced on a vba2c attempt? Which would have more of an effect? It's hard to figure out exactly what the risk is for a particular vbac, especially when there may be multiple risk factors.






Thanks for that link! I knew rupture in unscarred uteruses wasn't that rare!
The other thing that folks don't always seperate out is the degree of rupture. Partial ruptures are not necessarily emergent. Personally it's the catastrophic ruptures that I look at, not the ones that do no harm and require no treatment.

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Old 06-22-2007, 09:10 PM
 
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Nope, I"ve never lied to a Doctor, Nurse, or MW about my medical history.

I do plan on lying about my "due date", but not to the MW I might hire. I will tell friends and family that I'm due at least a month later than I am, so they won't be fussing at me to get an induction when the baby takes longer than what they consider "usual" to finish gestating.

I get HUGE. I am tiny, overweight, but short and small boned. I usually measure much larger than my dates would indicate. So, people really freak when they see me anyway. Friends, family and strangers try to comfort me by telling me how cruel my doctor is not to induce me and get it over with, which just upsets me. My first two were induced, and it was extremely traumatic. With my third there was no doctor, and I wanted it that way. The birth began naturally as God and Nature intended, two days shy of 44 weeks.

I"m just going to tell t hem "Marchish" and then they won't be able to say a thing to me about that, though I can't hide the size I'll be.

Kiley
I would think it would be difficult to lie to your care provider and say you've never had a c-section because even after 5 1/2 years I still have a scar (and although it is very low it is a little puckered in the middle and definitely still there). I guess if you had 2 c-sections you could try and lie and say you only had one, for example, my care provider for this pregnancy only asked for my c-section records from my 1st c-section and took my word for it that my second birth was a VBAC (each birth was at a different hospital). I guess if I had had a second c-section I could have lied about it and honestly would consider it if that was the only was I could get prenatal care. I don't believe that UC would ever be for me.

And about the due date thing, what is up with friends/family and due dates? I would tell people I was due at the beginning of February and they all wanted to know the exact date. I guess some people think it's cool if you're due on their birthday, their kids' birthdays, etc., but it's not like the baby is going to come on that day!
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Old 06-22-2007, 11:19 PM
 
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[QUOTE=oregonbound;8452923 I guess if you had 2 c-sections you could try and lie and say you only had one, for example, my care provider for this pregnancy only asked for my c-section records from my 1st c-section and took my word for it that my second birth was a VBAC (each birth was at a different hospital). [/QUOTE]

Nope, you get a scar for each c/s. I've got two scars for two c/s. What you could lie about would be if you had vaginal birth and then c/s. If you wanted, for some reason to say that your c/s was first, and that you've already VBAC'd. I'm just not sure what good that would do, but I know I've seen posts from moms planning something like that. I"d think the fact that you've had a vag birth would mean you could do it, period, even if something had happened in subsequent births that led to a c/s.

I've also known moms who lied about LMP to their practitioners, to get a later date, so they wouldn't get risked out of homebirth for going over dates. This makes sense to me, but I've not done it. My plan is to hire a MW who is OK with me going past dates, or not have a MW. Some people don't have that option, and would tell such a lie to protect their baby, which sounds fair to me.

Kiley
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Old 06-23-2007, 01:53 AM
 
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Originally Posted by dlm194 View Post
The 2004 NEJM study also includes women with vertical incisions, though that didn't seem to affect the overall rate of rupture (but those results were separated out to show the increased risks with non-low transverse scars).






From the 2004 study:

Quote:
Maternal and perinatal outcomes were compared between women who had a trial of labor and those who underwent elective repeated cesarean delivery without labor or other indications for cesarean delivery, such as a prior classical (up-and-down) or "inverted T" incision, breech or transverse presentation, placenta previa, prior myomectomy, nonreassuring patterns in the antepartum fetal heart rate, genital herpes, or a medical condition precluding a trial of labor.
Looks like they did not count women in the ERCS group that had any of the things listed, including prior classical or inverted T incisions. All of the the things they listed as being criteria to exclude a woman from the ERCS group are things that one would normally expect a CS delivery for regardless, so it makes sense to exclude them and only count the women that had an ERCS presumably ONLY because of the VBAC issue.



And here is where they gave the specifics on rupture rates for each type of incision, though the non-lower transverse incision groups were small and that should be taken into consideration.

Quote:
The rates of rupture were 105 of 14,483 (0.7 percent) for women with a prior low transverse incision, 2 of 102 (2.0 percent) for those with a prior low vertical incision, and 15 of 3206 (0.5 percent) for those with an unknown type of prior incision. Two uterine ruptures were recorded in 105 women (1.9 percent) with a prior classical, inverted T, or J incision who either presented in advanced labor or refused a repeated cesarean delivery.
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Old 06-23-2007, 02:26 AM
 
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I think it's highly unfortunate that we are living in a time where women would feel that they can't get evidence based care or have the ability to make their own decisions and feel they might have to lie to get the kind of care they want.
Unfortunately there is no *might* about it. The second I truthfully explained to my CNM and OB about not wanting a cesarean birth for my last child, my prenatal care went from warm and fuzzy and comforting to a nightmare that included threats and lies from THEIR side, and many many tears and sleepless nights on my side. If I had lied, my pregnancy would have been MUCH easier.
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Old 06-23-2007, 02:35 AM
 
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My first daughter was 9 pounds and got stuck coming out of me. They almost had to dislocate her shoulder to get her out.

When my second ended up being 10 pounds I didn't fight the c-section they said I should get becuase it was best for the baby,

Now I am 20 weeks and once again measuring big on top of that, this one is a boy. I could fight for a VBAC but i think it is in my child best interest to be delivered the safest way possible.
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Old 06-23-2007, 12:41 PM
 
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Originally Posted by wifeandmom View Post
From the 2004 study:



Looks like they did not count women in the ERCS group that had any of the things listed, including prior classical or inverted T incisions. All of the the things they listed as being criteria to exclude a woman from the ERCS group are things that one would normally expect a CS delivery for regardless, so it makes sense to exclude them and only count the women that had an ERCS presumably ONLY because of the VBAC issue.



And here is where they gave the specifics on rupture rates for each type of incision, though the non-lower transverse incision groups were small and that should be taken into consideration.
Yes, interestingly, they excluded any women from the ERCS group who had a medical reason for a repeat cesarean, but INCLUDED any woman in the trial of labor group who perhaps had a reason for a repeat but refused. They mention in the article that they included a number of women with classical incisisons who either showed up in advanced labor or refused surgery.
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Old 06-24-2007, 05:29 PM
 
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Yep, in a heartbeat. but i love my OB and refuse to find some sucker to take his place. He is more than happy to go with whatever DH and I want for the birth of our children.

now, whenever i get pg and my water breaks, i will lie about when it happened so i dont start the time clock that was applied last time.
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Old 06-24-2007, 09:03 PM
 
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And yet you love your surgeon? Was it the same one who applied the time rules to you?
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Old 06-25-2007, 10:14 PM
 
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Actually, I did. When I was seen at the ER at Kapi'olani after a fall at the zoo, I told them my first was a normal vaginal birth & my second was a c-section due to breech presentation, when in reality both were c-sections due to breech presentation. At the time I wasn't planning on returning to the hospital, but to give birth at home (UC), & since I was contracting at the time I was afraid they might try to keep me, so I wanted to not be pressured into a third surgery. When I did go into their hospital after all, I didn't correct myself.

I am very tempted to send them a letter explaining my lie and apologizing, if for no other reason than to let it be known a VBA2C can be had safely.

Sabra: Mama to Bobbie (3/02), Linda (1/04), Esther (10/05), Marie (11/10), & Douglas (11/12)

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