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#1 of 43 Old 06-14-2007, 03:15 PM - Thread Starter
 
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When you're struggling to find a VBAC supportive HCP have you ever lied (like flipping the order of birth histories) to make it appear you've already had a VBAC?

Being a UCer I don't have to deal with searching for a supportive HCP I can trust. I just wonder what you do when know one's on your side and you know what your doing is in you and your child's best interest. I don't like the idea of lying to someone who is supposed to be "on my side" but I just don't know what good solutions I could come up with if I weren't a UCer.

The only successful VBACers I know IRL are UCers plus one friend who labored at home for 3 1/2 days and got to the hospital 20 minutes before her 2nd DD was born. Around here you really have to drive at least 45 minutes to find a hospital that supports VBACs in theory.

~BV
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#2 of 43 Old 06-14-2007, 03:37 PM
 
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I would chime in...but I don't know what a Ucer is...

Mir
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#3 of 43 Old 06-14-2007, 03:53 PM
 
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hahaha, I also don't know what a UCer is or any of the other abreviations. Please enlighten me
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#4 of 43 Old 06-14-2007, 04:14 PM
 
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uc is unassisted childbirth, mothers delivering their own babies
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#5 of 43 Old 06-14-2007, 04:16 PM
 
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UC is unassisted childbirth.

I would lie if I felt I had to. I feel lucky that I'm not in that position.
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#6 of 43 Old 06-14-2007, 05:02 PM
 
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Realistically I couldn't lie, since I had 1 birth and it was CS...
Hospitals here are supposed to let you VBAC (I heard one doesn't) but it has to be in the consultant led L&D ward.

DD 01/2007, DS 09/2011

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#7 of 43 Old 06-14-2007, 11:24 PM
 
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I'd lie in a heartbeat. The risks of any birth are mine to decide, not a bunch of strangers who'll never see me again and birth is, after all, as safe as life gets I have friends in the US who've lied and said they've never had a c-sec at all. New state, new CP, if no one looks at your belly they won't know. In a climate like we have at the moment I support "by any means necessary" to get a baby birthed safely.
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#8 of 43 Old 06-14-2007, 11:45 PM - Thread Starter
 
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Originally Posted by meatloafkend View Post
hahaha, I also don't know what a UCer is or any of the other abreviations. Please enlighten me
Sorry. I get annoyed when my US Marines bil & sil speak in acronyms. I didn't mean to do it to you.
  • VBAC = Vaginal Birth After Cesarean section
  • HCP = Health Care Provider (midwife, general practictioner, ob/gyn, etc)
  • UC = Unassisted Childbirth i.e. no professional birth attendant
  • IRL = In Real Life i.e. people I know by name and face rather than screen nick

BTW (oops! By the way) I really appreciate everyone's honesty. I get so tired of dealing with medical prejudice against fat moms, fat babies, natural birthers, etc that I opt out of a lot of it. I can't imagine dealing with the pressure birth attendants fearful of birth let alone prejudice against VBACers.

~BV
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#9 of 43 Old 06-14-2007, 11:48 PM
 
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I'd like to know how you plan on having a HCP provide prenatal care and NOT see your belly or your c/s scar?

Do you mean, like if you had a vaginal birth and then a c/s lying about it and saying you had the c/s first and then a vaginal birth?

Ruth, single mommy to Leah, 19, Hannah, 18 (commuting to college), and Jack, 13(homeschooled)
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#10 of 43 Old 06-15-2007, 12:30 AM
 
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i'm pretty sure i am going to lie if i have to for the next one...i want a water birth at HOME...dh is so not thrilled... i wonder how i am going to pull that off...ds was born by LS CS... do what you gotta do!
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#11 of 43 Old 06-15-2007, 12:56 AM
 
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I would if I ever had no other choice.
My OB was such an incredible surgeon (really, she missed her true calling... plastic surgery), that even I can barely find my scar. Not to mention she did not write an operative note for my surgery. I could definitely get away with lying as far as them not being able to tell. I definitely wouldn't WANT to... but if I had no other choice I would.
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#12 of 43 Old 06-15-2007, 01:36 AM
 
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Originally Posted by Ruthla View Post
I'd like to know how you plan on having a HCP provide prenatal care and NOT see your belly or your c/s scar?
I've had three c-sections and I could certainly get away with lying. My scar is literally *right* at the top of my pubic bone, which is covered with pubic hair. And I'm not an overly hairy person or anything. It's just *that* low.

Would I recommend lying about previous sections? Probably not, but I wouldn't rule it out completely.

The problem could become what happens if you rupture? They aren't really looking as close for a rupture in a woman without a previous c-section since the chances are so incredibly low compared to VBAC moms (1 in 15,000-ish to 1 in 200-ish).

I would say mom better arm herself with a lot of knowledge on the signs of impending rupture so she could 'come clean' so to speak should the need arise.

Also, if something DID go wrong, any chance of suing for malpractice would basically be out the window, so it'd definitely be a choice you'd have to be 100% confident in and willing to accept the responsibility for ANYTHING that might go wrong, even if it really was the fault of whomever was seeing you.

How very sad it is to think that women actually have to contemplate lying in order to birth vaginally. I wish I knew what the answer was to this whole mess.
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#13 of 43 Old 06-15-2007, 03:18 AM
 
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Originally Posted by bryonyvaughn View Post
I really appreciate everyone's honesty.
Well, being honest about lying is a start.

If you ever needed to sue for malpractice, this lie might not be a good one to have told.
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#14 of 43 Old 06-15-2007, 09:15 AM - Thread Starter
 
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...The problem could become what happens if you rupture? They aren't really looking as close for a rupture in a woman without a previous c-section since the chances are so incredibly low compared to VBAC moms (1 in 15,000-ish to 1 in 200-ish)...
While the 'risk of rupture' card is frequently played on moms wanting to VBAC, I always thought the true risk of rupture correlated far more closely with Cytotc and Pitocin than with previous c/s. Did I get that wrong? It's probably been 8 years since I've read Obstetric Myths vs Research Realities.

If that was indeed the case, I could understanding someone lying about c/s history to get in a setting without cytotec/Pit but would be scared to do so if I were being pressured to induce or augment labor... especially if I had multiple c/s, surgical abortions, D&Cs, fetal surgeries, etc.

The reason I asked brought this up is sometimes my clients will tell me one thing but when I look at their urine or test their blood I know things don't add up. I'll explain the discrepancy between their story and test results, offer possible reasons for the test results, and wait for them to 'fess up. I don't do it to be mean but if they want me to help them I can do a much better job working with reality than an illusion.

I use the Golden Rule as a moral standard and realized if I were in a VBACing situation, I'd be sorely tempted to treat my HCPs differently than I like my clients to treat me. I was struggling with the idea of my being a big old hypocrite. Hearing your replies I think my Golden Rule dilemma is evidence that I'm far more open, accepting, and supportive of my clients than most HCP are toward VBACing moms.

That's all. Just me working through my moral quandaries on the VBAC board. While I quoted only wifeandmom, I thank you all for your input. It's help me.

~BV
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#15 of 43 Old 06-15-2007, 04:38 PM
 
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I don't know about pitocin, but VBAC does contraindicate being induced with prostaglandins--it significantly increases the rupture rate. I forget the stats, but I believe a repeat CS is safer than that type of induction.

The problem is that there is a risk of rupture with VBAC; unfortunately, that risk can be overstated and used to justify needless intervention. On the one hand, you want them to know you did have a CS so they're paying attention (uterine rupture being so much rarer in non-CS women that they don't think it's happening), on the other, with the restrictions on VBAC, you don't want to be setting yourself up to fail.

DD 01/2007, DS 09/2011

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#16 of 43 Old 06-15-2007, 07:28 PM
 
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I would be upfront. I also will NOT be seeing an MD - so no worries, LOL!

~Marie : Mom to DS(11), DS(10), DD(8), DD(4), DD(2), & Happily Married to DH 12 yrs.!
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#17 of 43 Old 06-15-2007, 08:01 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
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#18 of 43 Old 06-15-2007, 08:04 PM
 
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[QUOTE=bryonyvaughn;8390653]While the 'risk of rupture' card is frequently played on moms wanting to VBAC, I always thought the true risk of rupture correlated far more closely with Cytotc and Pitocin than with previous c/s. Did I get that wrong?


I've forgotten a lot since my last birth, but not that! Yes, you are right. Induction is the biggest risk factor whether or not you have a previous c/s. C/s does increase risk a bit, but nothing to the extent that induction does. There was a time I could rattle off the relavent percentages in a heartbeat.

Now that I've UBAC'd I don't worry so much.

Kiley
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#19 of 43 Old 06-16-2007, 12:12 AM
 
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[QUOTE=mom3b1?;8395328]
Quote:
Originally Posted by bryonyvaughn View Post


I've forgotten a lot since my last birth, but not that! Yes, you are right. Induction is the biggest risk factor whether or not you have a previous c/s. C/s does increase risk a bit, but nothing to the extent that induction does. There was a time I could rattle off the relavent percentages in a heartbeat.

Now that I've UBAC'd I don't worry so much.

Kiley
Two women, both being induced, one with a previous c-section and one without have *very* different rupture risks.

Every study I've seen agrees with this. A woman *without* a scarred uterus, induction or not, has a MUCH less likely chance of rupturing. I'd be interested to see reputable studies that claim otherwise.

I've yet to see *any* study that even came close to saying a non-induced VBAC had a rupture rate anywhere close to the 1 in 15,000 or less chance of rupture in an unscarred uterus. Certainly the risk is sometimes given as less than the 1 in 200 commonly given for the overall risk, but I've just never seen any reputable VBAC study showing non-induced rupture rates as low as rupture rates in non-scarred women.
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#20 of 43 Old 06-16-2007, 12:46 PM - Thread Starter
 
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Originally Posted by Ruthla View Post
...Do you mean, like if you had a vaginal birth and then a c/s lying about it and saying you had the c/s first and then a vaginal birth?
More along that line is what I was thinking. I was interested in any other "fudges" folks felt obliged to tell to get what they considered optimal care given their circumstances.

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Originally Posted by wifeandmom View Post
...How very sad it is to think that women actually have to contemplate lying in order to birth vaginally. I wish I knew what the answer was to this whole mess.
Dittos and sighs, my friend. Dittos and sighs.

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Originally Posted by AlexisT View Post
I don't know about pitocin, but VBAC does contraindicate being induced with prostaglandins--it significantly increases the rupture rate. I forget the stats, but I believe a repeat CS is safer than that type of induction.
I understand your point completely but it just makes me crazy when doctors use that as justification for repeat c/s rather than as justification not to induce. (I realize you're not justifying it, Alexis; I just had to micro-vent.)

Quote:
The problem is that there is a risk of rupture with VBAC; unfortunately, that risk can be overstated and used to justify needless intervention. On the one hand, you want them to know you did have a CS so they're paying attention (uterine rupture being so much rarer in non-CS women that they don't think it's happening), on the other, with the restrictions on VBAC, you don't want to be setting yourself up to fail.
It was just the beginning of last month I was at a Henci Goer talk and learned there were isolated cases of women being taken to court and ordered to undergo c/s. I knew many docs would give moms false encouragement to VBAC, only to insist on repeat c/s at term when no other HCPs would accept them. I just didn't realize some had persuaded judges to be hostile to VBACing moms too.

I *assumed* (and, yes, I realize "I assumed" could be among the most common last words ever spoken ) moms informed enough to pursue VBAC would be informed enough to know the risks of induction.

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Originally Posted by mom3b1? View Post
Nope, I"ve never lied to a Doctor, Nurse, or MW about my medical history.
I haven't either BUT I wouldn't consider it a moral badge. I feel no need to lie since I'll only go to doctors if I think they'll be able to help me. I've mastered the art of smiling sweetly and nodding while thinking, "This doc is an idiot."

Quote:
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.
Here, here! My past dates babies have averaged EDD+23d.

I've learned how to avoid lying by misleading with carefully placed facts. (How's that for moral high ground? )

Q: When are you due?
A: I'm expecting this baby the middle of January. Wouldn't it be neat if it shared it's sister's birthday?
DD's birthday is Jan 24th. EDD is calculated for Dec. 16

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Originally Posted by mom3b1? View Post
Two women, both being induced, one with a previous c-section and one without have *very* different rupture risks.

Every study I've seen agrees with this.
I agree.

Quote:
Originally Posted by wifeandmom View Post
A woman *without* a scarred uterus, induction or not, has a MUCH less likely chance of rupturing. I'd be interested to see reputable studies that claim otherwise.
Are you claiming a woman w/o a scarred uterus given Cytotec and Pitocin is less likely to have a uterine rupture than VBACing mom w/o the Cytotec and Pitocin?

I admit I gave away my copy of Obstetric Myths maybe eight years ago and haven't read a copy since but I got the impression it was the other way around?

Does anyone have references for this sort of study? I'm giving a talk next month as part of my Anat & Physio final and would like to know. I live near a university and, given the journal reference, can easily get copies of the articles.

BV, who needs to get better at googling
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#21 of 43 Old 06-16-2007, 01:55 PM
 
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Are you claiming a woman w/o a scarred uterus given Cytotec and Pitocin is less likely to have a uterine rupture than VBACing mom w/o the Cytotec and Pitocin?

Yes, that is exactly what I am saying.

What research says that I've seen is women with an UNscarred uterus have a *very* small chance of rupture, regardless of if they are induced or not. The stats come out in the 1 in 15,000-17,000 range.

Those numbers just are not going to drop to the level of rupture risk for a VBAC mom, which are commonly given as 1 in 200 or so. You might lower that risk to 1 in 1000 if you're incredibly lucky (pg spaced far enough apart, no induction, no augmentation, etc etc etc), but you aren't going to get close to in 1 in 15,000.

I can Google some this afternoon, but right now I've got a baby who needs me.
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#22 of 43 Old 06-16-2007, 05:43 PM
 
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What if the HCP orders your records? In my state as a home birth midwife, I need to order the records from the cesarean. I am not sure if this is routinely done by HCPs in the system... (need a better word for the md/hospital route.)
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#23 of 43 Old 06-16-2007, 07:19 PM
 
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Quick Google of NEJM study that looked at over 17,000 women who attempted VBAC in comparison to over 15,000 who went for ERCS.

Risk of rupture in NON-induced/NON-augmented group (something like 6000 or so fit into this category) was 0.4%. That's roughly 1 in 250 women who ruptured (they only counted full ruptures, nothing else).

Women who were augmented had a rupture rate of 0.9%, nearly 1 in 100, more than twice the risk overall of the women who weren't induced/augmented.

Any use of prostaglandin at all increased the rupture rate to 1.4%, or 3.5 times greater than the nothing-at-all group.

No prostaglandins (defined in the foot notes as manual dilation but no prostaglandins or pit) had a rupture rate of 0.9%.

Oxytocin (aka pit) alone used for induction had a rupture rate of 1.1%.

So, roughly 1 in 250 will rupture with nothing to augment/induce labor, 1 in 100 will rupture once the pit comes out, and 1 in 75 will rupture when prostaglandins are used.

Now....

Find me anything that says a NON-scarred uterus being induced or augmented, with or without prostaglandins, has a rupture rate anywhere near 1 in 250. It's just not true. The previous c-section scar is what jacks the numbers up so much. Inducing and/or augmenting don't help, but neither increase the risk nearly as much as the scar itself.
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#24 of 43 Old 06-16-2007, 08:09 PM - Thread Starter
 
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Quick Google of NEJM study that looked at over 17,000 women who attempted VBAC in comparison to over 15,000 who went for ERCS....

So, roughly 1 in 250 will rupture with nothing to augment/induce labor, 1 in 100 will rupture once the pit comes out, and 1 in 75 will rupture when prostaglandins are used.
Thanks for the lead. It got me 2001 article plus a lot of helpful related stuff.

Quote:
Now....

Find me anything that says a NON-scarred uterus being induced or augmented, with or without prostaglandins, has a rupture rate anywhere near 1 in 250. It's just not true. The previous c-section scar is what jacks the numbers up so much. Inducing and/or augmenting don't help, but neither increase the risk nearly as much as the scar itself.
I'll pass, thank you. I'm not looking for a debate but appreciate your setting me straight on the facts. The facts you've shown me has made me think the far more relevant questions are...
* How to decrease the rate of initial c/s?
* How to stitch a uterus to decrease rate of future rupture?
* How to accurately evaluate relative risk in current and future pregnancies of vaginal birth or repeat c/s?

I'm also left curious as to how uterine rupture was defined. I've heard some studies lump dehiscenses (is that the word for the benign windows?) in the statistics with true rupture.

Gotta eat.

Thank you all for your input on truth in the client/HCP relationship.

~BV
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#25 of 43 Old 06-16-2007, 09:52 PM
 
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I'd like to say no, I wouldn't lie. Right now, it's not an issue b/c I have very vbac supportive midwives. I don't have a need to lie. However, at my first appointment, the midwife could not find my csection scar. Going au natural helps . :

I totally agree with this:
Quote:
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I'd lie in a heartbeat. The risks of any birth are mine to decide, not a bunch of strangers who'll never see me again and birth is, after all, as safe as life gets
Doctors are out to protect their wallets. If they can LIE to me and claim that repeat csections are safer than vaginal births without presenting all the facts, then I wouldn't feel bad about lying about my birth. If this baby is a successful vaginal birth and we wind up living in a non-vbac friendly area for baby #3 (if we decide to have baby #3), I will have no problem saying I've only had a vaginal birth.

Quote:
I knew many docs would give moms false encouragement to VBAC, only to insist on repeat c/s at term when no other HCPs would accept them.
Grrrrr..... this happens a lot.



Regarding rupture risk. Yes, vbac has a rupture rate of about 1 in 200. That sounds freaky, scary, right? Not really. I HATE when people throw that around without explaining it. Very few of those result in death. Here is a great summary of vbac studies: http://www.storknet.com/cubbies/vbac/4studies.htm

Many studies DO include dehinscenses in the "rupture" count. We really don't know how many women vbac or just vaginally birth with dehiscenses.

Now, serious rupture is something to be concerned about. I am NOT downplaying it. There are women here and on the ICAN list that have lost babies due to ruptures so that is something to keep in mind.

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

Quite frankly ANY hospital should be prepared and looking for a uterine rupture. Banning vbacs is not going to end ruptures. We have hospitals near by that handle 7000 births per year with a 50% csection rate. Statistically speaking, they should expect at least 1 unscarred woman to rupture every other year using the 1 in 15,000 stat. Considering csections put women at greater risk for rupture, they should still have a couple a year. So I don't buy the "they won't expect a rupture if you don't tell them argument."

Bottom line is that doctors are going to do what's best for them at the patients expense so I need to do what's best for me (as all women should do)

ETA: on my nursing board, there was a question about witnessing ruptures. Over 1/3 of ruptures seen were in unscarred uteruses. Anecdotal evidence? Yes! But I wouldn't discount it as something to think about.
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#26 of 43 Old 06-16-2007, 09:55 PM
 
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What if the HCP orders your records? In my state as a home birth midwife, I need to order the records from the cesarean. I am not sure if this is routinely done by HCPs in the system... (need a better word for the md/hospital route.)
I wouldn't lie about my birth experiences to a good midwife who had a proven track record for vbac support and success. I think that's vital to establishing a good and trusting relationship.

Doctors and medwives are another story. I wouldn't be able to trust that they would be truly supportive and not turn on me at the last minute. What they don't know, can't hurt them.
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#27 of 43 Old 06-17-2007, 01:49 AM
 
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far more relevant questions are...
* How to decrease the rate of initial c/s?
Bolding mine, but I think this is the number one issue that, if addressed, would help solve much of the VBAC issue.

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* How to stitch a uterus to decrease rate of future rupture?
Not sure on this one, as there is already some evidence that double layer suturing decreases risk (to the point of providers not allowing VBAC in single layer closure moms). However, there are so many variables during surgery that the type and extent of suturing might very well need to be decided based upon getting mom out of THAT surgery alive and well, *not* so much based upon potential future pregnancies. Other factors would be the need to free up the OR and/or staff for other urgent cases, making time an issue with more invovled suturing.

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* How to accurately evaluate relative risk in current and future pregnancies of vaginal birth or repeat c/s?
That's the mystery question. Also, I think it would be nice if women were presented with the facts, given the choice, and allowed to accept responsibility for making that choice. It would eliminate, or at least greatly reduce, the malpractice exposure, and I personally know several OB's that would still attend VBACs if this were the case. Otherwise, it's considered too risky from a malpractice standpoint.

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I'm also left curious as to how uterine rupture was defined. I've heard some studies lump dehiscenses (is that the word for the benign windows?) in the statistics with true rupture.
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.
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#28 of 43 Old 06-21-2007, 04:35 PM
 
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I lied, & I would do it again in a heartbeat.

I attempted a homebirth after 3 c-sections with my last. After laboring for approximately 24 hrs, & not getting the support I needed, I trasported to the hospital.

I told them I had only one c-section. I labored for another 12 hrs, & ended up with a fourth c-section.

I may go unassisted next time. I'm reluctant to let midwives into my home...no matter how awesome they seem....the tables can turn mighty quickly.

 

  

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#29 of 43 Old 06-22-2007, 01:25 AM
 
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Originally Posted by wifeandmom View Post
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.
Are you talking about the 2001 study that sort of kicked off the whole anti-VBAC movement?
That study did not apparently only look at catastrophic rupture. It took data from birth certificates and hospital discharge diagnoses. It appears to have counted all ruptures. In the whole study there were 91 uterine ruptures with 5 infant deaths (about a 5.5% death rate - and 11 of the ruptures were in women who had elective repeat cesareans. They actually don't comment in the study on what classifies as uterine rupture, and don't use the word "dehiscense" in the study, but given the death rate, I'm guessing all uterine ruptures are included, since catastrophic rupture generally has a higher death rate.) This study does not comment on other infant outcomes like NICU admission.
I don't know if I can link the full text, but here's an attempt:
http://content.nejm.org/cgi/content/full/345/1/3
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#30 of 43 Old 06-22-2007, 11:38 AM
 
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Originally Posted by doctorjen View Post
Are you talking about the 2001 study that sort of kicked off the whole anti-VBAC movement?
That study did not apparently only look at catastrophic rupture. It took data from birth certificates and hospital discharge diagnoses. It appears to have counted all ruptures. In the whole study there were 91 uterine ruptures with 5 infant deaths (about a 5.5% death rate - and 11 of the ruptures were in women who had elective repeat cesareans. They actually don't comment in the study on what classifies as uterine rupture, and don't use the word "dehiscense" in the study, but given the death rate, I'm guessing all uterine ruptures are included, since catastrophic rupture generally has a higher death rate.) This study does not comment on other infant outcomes like NICU admission.
I don't know if I can link the full text, but here's an attempt:
http://content.nejm.org/cgi/content/full/345/1/3
No, the one I was talking about was from 2004. From the article itself:

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Uterine rupture was defined as a disruption or tear of the uterine muscle and visceral peritoneum or a separation of the uterine muscle with extension to the bladder or broad ligament. Uterine dehiscence was defined as a disruption of the uterine muscle with intact serosa.
So they define the difference between the two very early in the article. And it was *not* a study where they simply looked at birth certificate data.

I don't think you can link to entire articles there, as you have to be signed in to read all of it. I will come back later with more from the article itself.
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