why are repeat c-sections so dangerous? - Mothering Forums

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#1 of 52 Old 08-08-2007, 05:44 PM - Thread Starter
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I'm pg with #4, and the first 2 attempts ended in c-sections for different reasons... during my last c, the ob said my uterus was 'very' thin... and if I got pg again, I might want to consider another c (and I got pg 6mos after DS was born, so not sure how well my uterus has healed). But I'm hearing that multiple c's are actually more dangerous than vbacs... why? Any info you can give me to help make the right decision would be great. I thought I read on everything from ICAN's website for my first vbac attempt, but now that I'm here again, I definitely need refresher information.

thanks!!
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#2 of 52 Old 08-08-2007, 06:25 PM
 
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http://www.lamaze.org/institute/adva...nsequences.pdf
and the link is defunct, but another article:
Infant Deaths After C-Sections Rise Even in Low-Risk Pregnancies

Thu Aug 31, 11:48 PM ET

THURSDAY, Aug. 31 (HealthDay News) -- Among U.S. women with low-risk
pregnancies, those who opt for Caesarean section have higher infant and
neonatal death rates than women who deliver vaginally, a new study finds.
ADVERTISEMENT

Researchers at the U.S. Centers for Disease Control and Prevention analyzed
data from more than 5.7 million live births and nearly 12,000 infant deaths
over a four-year period.

Overall, neonatal (younger than 28 days) deaths were rare for infants of
low-risk women. The rate was about one death per 1,000 live births.

However, the study found that the death rate among neonatal infants
delivered by Caesarean section was more than twice that of infants delivered
vaginally. This held true even after the researchers adjusted for
socio-demographic and medical risk factors.

The researchers noted that there was a 41 percent increase from 1996 to 2004
in the number of U.S. babies delivered by Caesarean section. According to
the National Center for Health Statistics, nearly 1.2 million C-sections --
29.1 percent of all births -- were performed in the United States in 2004.

"These findings should be of concern for clinicians and policy makers who
are observing the rapid growth in the number of primary Caesareans to
mothers without a medical indication," lead researcher Marian MacDorman, a
CDC statistician and senior social scientist, said in a prepared statement.

She's also co-chair of the SIDS and Infant Mortality Committee for the
American Public Health Association.

"While timely Caesareans in response to medical conditions have proven to be
life-saving interventions for countless mothers and babies, we are currently
witnessing a different phenomenon -- a growing number of primary Caesareans
without a reported medical condition," MacDorman said. "Although the
neonatal mortality rate for this group of low-risk women remains low
regardless of the method of delivery, the resulting increase in the
Caesarean rate may inadvertently be putting a larger population of babies at
increased risk for neonatal mortality."

The study was published in the latest issue of the journal Birth: Issues in
Perinatal Care.

More information

The American College of Obstetricians and Gynecologists has more about
patient-requested Caesarean delivery.


and another

Caesarean birth triples maternal death risk

Thu Aug 31, 3:45 PM ET

LOS ANGELES (Reuters) - A Caesarean delivery more than triples a woman's
risk of dying in childbirth compared to a vaginal birth, according to a new
study from France.
ADVERTISEMENT

The risk is still quite small, but many developed countries have seen a
dramatic rise in the number of Caesareans performed each year as more women
elect to avoid a vaginal delivery.

Researchers, led by Catherine Deneux-Tharaux of the Maternite Hopital Tenon
in Paris, looked at 65 maternal deaths recorded in the French National
Perinatal Survey from 1996 to 2000.

All of the deaths followed births of a single child and were not due to
conditions existing prior to delivery. The women had also not been
hospitalized during pregnancy.

The researchers found that the risk of death -- from blood clots, infection
or complications from anesthesia -- was 3.6 times higher for women who had
Caesareans.

The risk of death after childbirth was increased whether or not the
Caesarean was performed before the onset of labor or during labor.

The study was published in the September issue of Obstetrics & Gynecology.

Although rates of maternal death in most developed countries are relatively
low -- U.S. women have a 1 in 3,500 chance of pregnancy-related death -- the
incidence of maternal mortality has not significantly decreased in the last
two decades, according to American College of Obstetricians and
Gynecologists.


you can google "risks of repeat cesarean" as well
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#3 of 52 Old 08-08-2007, 07:58 PM
 
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Hi, a really quick reply here! I just came across these facts:

The risk of a mother who has one past caesarean ending up with a hysterectomy after a subsequent caesarean was 1 in 90, according to a recent study from the UK. However, for women having a vaginal birth who did not have a past caesarean, the rate was only 1 in 5,189.

A study of mothers in the Netherlands between 1983 and 1992 found that the death rate from caesareans was seven times that from vaginal birth.

I also remember reading recently, that for your 1st c/section it takes approx 5 minutes to get the baby out from the time they make the first cut. For each subsequent (sp?) c/s the time increases. With c/s number 4 it takes approx. 18 minutes to get the baby out from the time they make the 1st cut. It's a much more difficult operation, as there can be a lot of adhesions and scar tissue from the previous surgeries.

I'm hoping for a VBA3C this time. I feel that with 3 children already to care for I really don't want to do anything that seriously risks my health or my life. I believe for a VBA3C the chances uterine rupture are 0.7% (or was it 0.9%?) Anyway - it's a tiny percentage. I have a 99% chance of not having a ruptured uterus! Also, who knows what they are recording as a rupture. One of my scars seperated slightly last time. It did not cause any harm to me or my baby. It might have been recorded as a rupture though.

Good luck with your decision. It's so hard to know what to do for the best sometimes. I hope you can find a solution you are happy with.
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#4 of 52 Old 08-09-2007, 03:36 AM
 
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Originally Posted by sarah0404 View Post


I also remember reading recently, that for your 1st c/section it takes approx 5 minutes to get the baby out from the time they make the first cut. For each subsequent (sp?) c/s the time increases. With c/s number 4 it takes approx. 18 minutes to get the baby out from the time they make the 1st cut. It's a much more difficult operation, as there can be a lot of adhesions and scar tissue from the previous surgeries.
Interesting. I do believe it takes longer on average to perform subsequent c-sections when dealing with scar tissue and/or adhesions. However, FWIW, my third section was by far the fastest of the three. From first incision to completely closed was 20 minutes on the dot, so it obviously didn't take even close to 18 minutes to get baby out.

The flip side of this argument (that women shouldn't have ERCS cause it's a more difficult operation) should be considered, because many OB's will mention it to patients as a reason TO have an ERCS. What happens if baby goes into distress for whatever reason necessitating an emergency c-section? It's still going to take longer to get to baby, but now baby is in trouble vs. during an ERCS where taking 18 minutes isn't a big deal because baby is fine. I had that argument presented to me and had honestly never thought of it that way, but it does make sense to at least consider it, if for no other reason than to not be taken by surprise if it does come up.

As for the OP, many of the risk factors for multiple c-sections are present during subsequent pg *regardless* of whether or not you choose ERCS or VBAC. Of course there is the risk of UR. However, there are risks that increase fairly significantly with each subsequent c-section that apply to the pregnancy in general. Placental abruption, placenta previa, and placenta accreta come to mind right away. The obvious theme there is a problem with the placenta, and it should be fairly obvious to most people that the uterus simply isn't designed to be cut into over and over and over again.

There are very real risks associated with future pregnancies after c-sections, risks that increase with each additional c-section. It would be wise IMO to consider the overall family size planned by each individual woman when making the ultimate decision of whether or not VBAC or ERCS is the right choice.
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#5 of 52 Old 08-10-2007, 07:46 AM
 
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The flip side of this argument (that women shouldn't have ERCS cause it's a more difficult operation) should be considered, because many OB's will mention it to patients as a reason TO have an ERCS. What happens if baby goes into distress for whatever reason necessitating an emergency c-section? It's still going to take longer to get to baby, but now baby is in trouble vs. during an ERCS where taking 18 minutes isn't a big deal because baby is fine. I had that argument presented to me and had honestly never thought of it that way, but it does make sense to at least consider it, if for no other reason than to not be taken by surprise if it does come up.
I thought about this too. If I had a real emergency would 18 minutes be too long? But I wonder how many emergency c/s are actually REAL emergencies? Things like cord prolapse yes but often where the baby isn't tolerating labour well and getting distressed it isn't quite a life or death situation. I was thinking, in a life or death emergency maybe they could do the classical style incision, so they wouldn't have to mess around with old scar tissue. I'm not sure how fast that kind of op is though.

On a different note: I couldn't sleep last night, and for some reason ended up thinking about Michael Jacksons nose! That seems like the perfect advert not to have surgery done in the same place multiple times!
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#6 of 52 Old 08-10-2007, 11:44 AM
 
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seems like the perfect advert not to have surgery done in the same place multiple times!
Oh dear!

My OB told me when I asked about an emergency repeat that they would put me under general and have the babe out "pretty damn fast"...the "cost" for that though is a larger incision, usually a classic incision, and a harder recovery for mama since getting to the babe is the priority (instead of going slow and "gentle" for mama). She also said it wasn't something to worry about, that vbacs are perfectly normal births and the chance of something really bad happening are low.

So be prepared but don't let the thought of a mid-birth repeat take over!

OP- A c/s is a serious surgical procedure. With each c/s your risk for complications go up...an increased chance of secondary infertility, an increased chance of ectopic pregnancy, pregnancy complications like the placental attachment disorders mentioned above, stillbirth, higher risk for UR during pregnancy as well as during the birth, even a harder time finding supportive birth attendants!

Obviously there are mamas who can and do birth past these "risks" but it's better not to have these worries/risks in the first place...

Also, there are the basic risks of major surgery. You may heal well the first time, but there is no promise that a second surgery will go as well. So if you don't NEED the surgery it's better for you too to avoid it!

congrats on the new babe!

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#7 of 52 Old 08-10-2007, 04:35 PM
 
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I haven't read all the replies so I apologize if I am repeating here. I think ERC are "more" dangerous than a primary c-section that is done for good cause because the benefits no longer outweigh the risks at that point. For example, if you have a primary c-section for a genuinely emergency situation (which is rare but that's another story!) the risks of the surgery are far outweighed by the benefits of getting that babe out. But in a RC where the mother is low-risk and there is no emergency situation then there is no risk-to-benefit ratio like there was in the genuine emergency situation. Am I making sense?
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#8 of 52 Old 08-10-2007, 05:23 PM - Thread Starter
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wow - this is amazing information - thank you so much for the discussions! I have lots to think about... here are a few more questions:

Regarding these issues:
placental abruption, placenta previa, and placenta accreta
-- Can you refresh me on what each of these means?
-- are they a problem during the pregnancy for a woman who has already had a c-section? or can they be a problem during the vbac attempt? or more a problem when ttc?

My last dr. tried to scare me into an elective c by saying cerebal palsy is a huge risk for vbacs... how is that so? I never heard that before... hence, I switched to the mw practice... what causes cerebal palsy?

We're hoping this is our last babe (#4 is more than enough! ) so ttc in the future isn't really too big of an issue, but I want to make sure this current pregnancy is safe and healthy, as well as the delivery method.

tia again!!!
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#9 of 52 Old 08-10-2007, 05:35 PM
 
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#10 of 52 Old 08-10-2007, 05:49 PM
 
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Spu-

Placenta previa- placenta is low and covers all or part of the cervix
Placenta accreta- placenta grows through the uterine wall (often through the prior scar) and attaches to other organs
Placental abruption- placenta pulls away from the uterine wall before baby is born

All of these are serious and are more common in women with scars on their uterus (but can affect all women). Placenta previa and accreta are mostly a problem at birth since the placenta isn't where it "should" be. Both require c/s for the safety of mama and babe. Accreta often leads to hysterectomy or additional surgery as well.

Abruption can cause a problem at any time during pregnancy and birth.

Cerebral Palsy is a specific set of conditions linked to non-progressive brain damage. Doctors don't actually know what causes CP though there are lots of possible options...low oxygen/lack of oxygen during birth or other birth trauma to the head is a possible cause. Preemie babes are at higher risk, babes with infections are at higher risk, and babes who experience low oxygen situations after birth are also at higher risk.

As far as I can tell, VBACs are at no greater risk for CP than any other vaginal birth. And a c/s wouldn't prevent all the possible causes of CP either so... I have no idea where your doc is getting that info or why they would bring it up!

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#11 of 52 Old 08-10-2007, 05:54 PM
 
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Originally Posted by wombatclay View Post
Oh dear!

My OB told me when I asked about an emergency repeat that they would put me under general and have the babe out "pretty damn fast"...
According to a good friend of mine who is a 4th year OB resident, she can get a kid out in about 2 minutes if necessary.

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#12 of 52 Old 08-10-2007, 06:50 PM
 
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Don't forget the non-pregnancy related long term consequences of c/s (and only compouned by multiple c/s) - bowel obstruction (the same is true of all abdominal surgeries from what I understand). IMO it's a very under-mentioned complication, but one that needs to be considered as well.
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#13 of 52 Old 08-21-2007, 04:31 AM
 
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Spu-
Placenta accreta- placenta grows through the uterine wall (often through the prior scar) and attaches to other organs
Actually, in placenta accreta the placenta does not normally grow completely through the uterine wall but attaches to the myometrium, the middle layer of the uterine wall. It's only in one of it's rare forms (placenta percreta) where it goes through the entire wall and can attach to other organs.

A woman's chances of having placenta accreta are next to nothing if she's had no c-sections but are 0.3% if she has had one c-section, 2% if she's had 3 c-sections, and it goes up from there.
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#14 of 52 Old 08-21-2007, 01:36 PM
 
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hm, interesting question. i've only had 1 section, so i haven't paid too much attention to the data on multiple sections.

here's what i'm finding, generally: both VBAC and ERCS are riskier for the mother after multiple sections. ERCS tends to be riskier for the mother in terms of serious complications, less risky as far as minor complications go (seems counterintuituve).
VBAC seems to be riskier for the baby compared to ERCS. this is not what i want to keep seeing, but i keeps seeing it, and i'm resigning myself to it. the risks for the baby in your current pregnancy are greater if you VBAC. the risks for a next baby (just in case there is one) get higher if you section.

talk about a crappy spot to be in, huh? it's really been weighting on my mind lately.
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VBAC seems to be riskier for the baby compared to ERCS. this is not what i want to keep seeing, but i keeps seeing it, and i'm resigning myself to it. the risks for the baby in your current pregnancy are greater if you VBAC. the risks for a next baby (just in case there is one) get higher if you section.
I"m sorry but I don't really understand this logic. Elective rcs is riskier than VBAC which is riskier than emergency rcs? But the chance that an emergency rcs would be necessary is less than 1% (in terms of uterine rupture, which really is the only difference between vbac and another low-risk pregnancy in terms of emergency rcs for the baby). How does that equate to "the risks for the baby in your current pregnancy are greater if you VBAC"? Don't mean to be combative, just don't follow you.

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#16 of 52 Old 08-22-2007, 11:24 AM
 
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holly6737- There are some studies that suggest that an scheduled section carries fewer risks for the baby than a repeat c/s done after labor is underway (not necessarily an "emergency", just an unplanned c/s). This is why some care providers argue against VBAC... although a successful VBAC is better for mama and babe than a c/s, a planned c/s is better than an unplanned one (I hate the term "failed vbac" but that's what you see in the literature).

But other studies show little difference between babes born via planned or unplanned c/s. The surgery carries risks for the babe too, and although planning can mitigate some of those risks, the babe is still exposed to some level of risk through the surgery itself (not just the events leading to the c/s).

A search of PubMed for terms like VBAC, Trial of Labor, Cesarean, Failed VBAC or Risk will pull up a variety of sudies on both sides of the fence.

And for the other bit majormahor brought up...risks increase with each surgery, so the more c/s you have had the higher your risk for various complications becomes. VBAC after multiple c/s is certainy possible (just ask the mamas here who have done it!) but it takes a bit more research and confidence and searching. So while a planned c/s might (depending on the study) carry fewer risks for the babe you are carrying now, it raises your risk of complications for a future pregnancy.

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#17 of 52 Old 08-22-2007, 11:25 AM
 
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I"m sorry but I don't really understand this logic. Elective rcs is riskier than VBAC which is riskier than emergency rcs? But the chance that an emergency rcs would be necessary is less than 1% (in terms of uterine rupture, which really is the only difference between vbac and another low-risk pregnancy in terms of emergency rcs for the baby). How does that equate to "the risks for the baby in your current pregnancy are greater if you VBAC"? Don't mean to be combative, just don't follow you.
in general, i'm seeing for baby, from safest to riskiest: elective CS, successful VBAC, emergency CS.
for mom, from safest to riskiest: successful VBAC, elective CS, emergency CS.

if you fold emergency CS into VBAC, it's still elective CS then VBAC for baby, VBAC then elective CS for mom.

part of the risk from VBAC comes from the fact that a first time vaginal delivery (if your VBAC is a first time. mine will be, i should have specified that! that affects all of the statistics) is more dangerous than a second one.

i'm sorry if this post is all over the place. DD is all over the place this morning.

as for the increased risk of VBAC, i'm pretty sure that VBACing increases your risk of placental problems too, which increases the baby's chance of death during labor. but i haven't looked for rates of placental problems (abruption, previa and accretia specifically) and compared them to non VBAC or CS, so i don't really know how that plays out yet.

ok have to go!
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as for the increased risk of VBAC, i'm pretty sure that VBACing increases your risk of placental problems too,
Birth method does not increase or decrease risks of placental problems. The initial surgery increases these risks so unfortunately if you have a c/s or other uterine suregry in your past then the increased risk is already there by the time your next delivery comes around.

Placental problems can complicate both a vaginal delivery (in some cases a successful vaginal delivery would not be possible) and can also complicate a repeat c/s (due to the location of the placenta). But it's not the birth method that is causing the problem, it's the placenta's location/attachment.

Good luck with your VBAC!

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#19 of 52 Old 08-22-2007, 12:04 PM
 
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Ok, right, but I guess I'm talking about overall risk?? I have read those articles about emergency rc/s being riskier than elective rc/s when planning my HBAC, but since the chance of me having to have an emergency c/s was somewhere around 3% (and that's being generous) I didn't pay too much attention to them.

As in, what percentage of the time in planned vbacs do emergency c/s really become necessary where it would have been safer to have planned an elective c/s from the beginning, see what I'm saying? The previous poster made the comment that for the baby being carried now, elective c/s would be the safest choice, to which I'm saying, yes, if it was 100% that she would end up with an emergency c/s, but the chances of that are very small, so the risks involved with vbac are still smaller than the risks involved with elective c/s.

Or is that what the literature was saying?

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#20 of 52 Old 08-22-2007, 12:15 PM
 
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Some studies say that c/s is safer than vbac for the babe. Others don't. If dd falls asleep I'll see what I can find...

But like they say, it's lies, damn lies, and statistics. I think a determined mother with a strong support team trumps the numbers more often than not!

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#21 of 52 Old 08-22-2007, 12:42 PM
 
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i've seen a lot of studies that show an elective c/s is safer than a VBAC (and i've seen studies that show the opposite. generally, though, the c/s looks safer). the problem is, you can't know until after the birth whether you'll need the emergency c/s or not. so you have to look at outcomes for everyone who goes in planning a vbac. ICAN (international cesarean awareness network, www.ican-online.org) quotes in their vermont/NH VBAC project that women who go into labor hoping for a VBAC have about a 6/1000 chance of fetal death, vs ecs with a 3/1000 chance of fetal death. i've seen this with other studies too. it's not what i want to be true, but i really do think it is.

i know that it's the c/s that increases the risk of placental problems. but laboring with an increased chance of placental problems is riskier than a c/s with a higher risk of placental problems. the studies that list causes of infant death in VBAC labors seem to have about as many incidences of abruption as they have rupture.

have to go again!
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#22 of 52 Old 08-22-2007, 12:47 PM
 
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Random (and fast) search of Pubmed. A more detailed search might give more specific results but dd2 has colic and I'm running on next to no sleep!

Obstet Gynecol. 1999 May;93(5 Pt 1):674-9.
Quote:
RESULTS: The only significant differences were noted between those patients who delivered vaginally after a prior cesarean and those patients who delivered vaginally without a prior cesarean. Neonates in the successful VBAC group were more likely to have an Apgar score at 5 minutes less than 7 (OR 1.52) or an umbilical arterial pH less than 7.1 (OR 1.69). Those neonates, however, were not at greater risk for an Apgar score less than 4 or a pH less than 7.0.
(but their ultimate conclusion was that vbac was still low risk despite these findings)

J Obstet Gynaecol Res. 1998 Apr;24(2):129-34
Quote:
CONCLUSIONS: A trial of a VBAC significantly reduced the rate of cesarean sections. Although the rates of uterine rupture and neonatal asphyxia were slightly higher in women who attempted a VBAC than in women who underwent an elective cesarean section, obstetricians should offer the option of a trial of labor, because more than one-half of the women with a previous cesarean delivery might have successful vaginal deliveries, and the VBAC-related maternal mortality rate does not reportedly differ between women undergoing a trial of labor and women undergoing an elective repeat cesarean section.
(but they point out in their findings that the vbac group included babes with complications not seen in the c/s babes, including lower apgars)

N Engl J Med. 1996 Sep 5;335(10):689-95
Quote:
Apgar scores, admission to the neonatal intensive care unit, and perinatal mortality were similar among the infants whose mothers had a trial of labor and those whose mothers underwent elective cesarean section.
(this study points out a higher maternal risk from vbac, but not a higher infant risk)

J Matern Fetal Neonatal Med. 2004 Jun;15(6):388-93.
Quote:
CONCLUSIONS: Favorable initial pelvic examination, spontaneous labor and a lack of oxytocin use are associated with successful VBAC in women with a single prior low transverse Cesarean delivery and no prior vaginal deliveries. While attempted VBAC and failed VBAC have more maternal infectious morbidity and lower Apgar scores, infant outcomes are similar to those of elective repeat Cesarean delivery.
(in this study "attempted vbac" seems to mean "successful vbac" since they contrast it with "failed vbac". The findings do indicate a slightly higher level of risk for vbac babes and lower apgars, but it wasn't a "significant" difference.)

Okay...there are more but these are fairly representative. I didn't include any rabid anti-vbac papers since honestly I don't think "rabid-anything" lends itself to rational scientific inquiry. In general the studies show vbac babes have lower apgar scores and a higher risk for certain birth complications. However these risks don't appear to be severe and since a c/s isn't risk free for the babe either (I didn't find any studies comparing wet lung c/s babe rates to low apgar vbac babe rates for example) I don't know that they should influence a mama's decision.

Though it's always good to know what research is out there so you can discuss or explain your birth choice to care providers/family...

ETA- you all probably know the site, but http://www.worldserver.com/turk/birt...bac2005-9.html maintains a collection of national and international vbac research. It's really well organized with summaries of the research findings. The site is maintained by a family with a sort of sad vbac story so don't go past the bibliography page if that will be upsetting to you...I know I read their personal story while pregnant and cried for hours so, um, just so you know ahead of time in case your pregnancy hormones are like mine were!

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#23 of 52 Old 08-22-2007, 01:53 PM
 
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One thing to remember when talking about these scientific articles is that these vbacs took place in the hospital, which normally means a good amount of interventions. Were the labors augmented? Were the women given the freedom to move around during labor? Did they have epidurals, etc.? What about fetal monitoring, etc? AROM? Vaginal exams? Inductions? All of these interventions bring with them risks which would not be present in c/s deliveries. Many times, hospitals make vbac labors actually have more interventions which would also affect the vbac vs. low-risk labors. Which is, of course, why I think more vbacs should be done at home.

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#24 of 52 Old 08-22-2007, 02:38 PM
 
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here's a study that shows a higher risk of fetal death in VBAC. i have looked at it but haven't searched around for criticisms yet.
http://jama.ama-assn.org/cgi/content/full/287/20/2684

and i like this one because they discuss (briefly) the causes of fetal death:
http://www.greenjournal.org/cgi/content/full/93/3/332

i disagree, though, the VBAC is safer at home. i know a lot of women here feel differently, i just can't see how distancing yourself from an OR could make things safer.
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#25 of 52 Old 08-22-2007, 02:52 PM
 
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holly- Of course! And there are no good randomized studies either (though one is in the works) since most mamas are not going to be okay with being randomly assigned to a repeat c/s or vbac pool at 36 weeks. And birth outcomes are not exactly cut and dried...so many little things can have a huge impact and you simply can't correct or control for all of them!

I think studies and stats are important (I'm a reference librarian ) but I don't think they are necessarily significant/predictive for any specific mama.

majormajor- the question might be easier to see if you look at vbac as simply another birth. Yes, there are risks that aren't present in a birth without a uterine scar but these risks are extremely low. Anyway, if you consider a vbac with a single low transverse incision to be a plain old birth (how my OBs viewed it btw) then being in a hospital does nothing but increase your chances for interventions and increase your chances for the complications/health risks that those interventions can lead to.

I had a hospital vbac. I'm glad I did. But my hospital and care providers both take the stance that birth is normal and natural and a vbac is "just" a birth. There are no routine interventions other than a heplock and intermittent monitoring with a doppler while pushing. That's it. No clocks, expected positions, gowns, denial of food, directed pushing, pressure to accept medication or interventions like arom, etc. The active management of birth in a hospital setting introduces risks you wont find elsewhere in exchange for easy access to an OR on the slim chance that you'll need it. When you compare vbac success rates in different birthing environments you'll find the odds really are against you in most hospital settings.

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#26 of 52 Old 08-22-2007, 03:14 PM
 
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i know this is MDC and i might get flamed for this, but i'm not convinced that homebirth is as safe as hospital birth. :
i've actually looked into it pretty extensively, and i don't want to shift the discussion to homebirth, so that's all i'll say about it.

however, you're absolutely right that some hospital interventions decrease VBAC safety. some increase it, though. i'm confident in my ability to say no to the dangerous ones and yes to the good ones, so it's absolutely going to be a hospital for me if i VBAC. the real problem i'm having is whether i'll end up VBACing at all, or whether i'll go for the scheduled CS. i'm heavily leaning towards the VBAC. i'm just really bothered by the increased chance of the baby dying with it. so, i don't know. i'm expecting to change my mind a hundred times before the next baby is born though.
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#27 of 52 Old 08-22-2007, 03:39 PM
 
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No worries majormajor...I'm not trying to convince you one way or the other, just explain the reasoning behind the hospital concern. As I mentioned, I vbac'd in a hospital and so have plenty of other mamas here at mdc and elsewhere. I'm just an information junkie who likes to share.

Are you currently pregnant? Do you have a vbac supportive care provider or a care provider that you're considering? They maybe could help you work through some of these concerns.

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#28 of 52 Old 08-22-2007, 04:44 PM
 
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Originally Posted by wombatclay View Post
i
I had a hospital vbac. I'm glad I did. But my hospital and care providers both take the stance that birth is normal and natural and a vbac is "just" a birth. There are no routine interventions other than a heplock and intermittent monitoring with a doppler while pushing. That's it. No clocks, expected positions, gowns, denial of food, directed pushing, pressure to accept medication or interventions like arom, etc.
I really think this would be ideal for most women. It's unfair that many women in our country have to choose between either a forced repeat c/s (or a highly managed vbac, really, if they're lucky) and a home birth, which unfortunately in many states it's illegal for HBACs to be attended. Women should have the right to have VBACs in a hospital without intervention. Unfortunately, cases like that are few and far between with so many hospitals banning vbacs or only allowing vbacs with epidurals, or internal monitoring, or whatever ridiculous rules they have.

If anyone is on the fence about vbac, I would recommend reading "Silent Knife" by Nancy Wainer Cohen. It is a little, um, strong, and it's an older book, but what she says still applies today, really, and it's what finally convinced me to vbac.

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#29 of 52 Old 08-22-2007, 04:51 PM
 
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we're just getting ready to start TTC. the OB who delivered my DD retired from delivering babies, so i'm about to start looking for a new one. my old OB was very pro-VBAC, and has told me several times that i'm a great candidate for one and has been SO supportive. she even apologized to me for having to go through labor and a section, but said that "my next labor will go like a second labor" because my body will remember the first, so it wasn't all for nothing.
anyway, you're absolutely right, a good provider that i trust will really help with this decision. i know i need to hear that most of the time, everything goes really well.

that's why i love this forum. so overwhelmingly supportive and positive. i usuallly try to just not post when i'm feeling down about VBAC. today is an exception!

also am totally with you both about freedom to choose where and how we all have our next babies.
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#30 of 52 Old 08-23-2007, 03:14 PM
 
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Quote:
Originally Posted by majormajor View Post
i know this is MDC and i might get flamed for this, but i'm not convinced that homebirth is as safe as hospital birth. :
i've actually looked into it pretty extensively, and i don't want to shift the discussion to homebirth, so that's all i'll say about it.

however, you're absolutely right that some hospital interventions decrease VBAC safety. some increase it, though. i'm confident in my ability to say no to the dangerous ones and yes to the good ones, so it's absolutely going to be a hospital for me if i VBAC.
See...I'm not, because I've never had "no" listened to the hospital at all. The reality is that I have at least some control of my environment at home...and none at all at the hospital.

Something I have noticed frequently when women choose ERCS is that they will think and say things like, "at least I know what to expect - after all, I've already had a c-section". I've had three. They were all different. I dodged the "complications" bullet until number three. Now, I don't know when I have to pee, because I can't feel my bladder, and I've lost a lot of sensation in my entire pelvis and lower abdomen. It took about a year and a half before I could even begin to figure out what worked for me sexually again, because nothing feels even remotely the same (formerly sensitive areas that are now just dead, etc.). I've had problems with gas and digestive upsets ever since the surgery. (My doctor said they couldn't possibly be from the surgery, and must be because I'm eating too many carbohydrates. Yeah - no dietary changes at all, but my diet must be causing this whole new problem...not to mention that she had no idea what I was eating...and my diet wasn't carbohydrate intensive.)

The "I know what to expect" comfort zone is an illusion. I'm not saying anyone here is counting on that, but it's something that really makes me a little nuts.

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