anyone who hasn't made up their mind about VBAC yet? - Page 2 - Mothering Forums
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#31 of 47 Old 09-25-2007, 05:26 PM - Thread Starter
 
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Sarah0404-what a tough place to be in! keep us posted on your progress and decision--i hope babe gives you a bit more time to get everything straightened out!

i just heard back from the vermont/new hampshire VBAC project. they said 6 in 10,000 is the chance of fetal death during a VBAC labor due to uterine rupture, and 6/1,000 is the overall chance of fetal death in a VBAC labor. similarly, 3/10,000 is the death risk from uterine rupture in a planned c/s, 3 in 1,000 is the overall c/s death rate.

really interesting. i think 6 (and 3) in 10,000 are low rates for death due to rupture, so i like those a lot. however, 6 and 3 in 1,000 are so high! i need to read back through the info they have on this project.
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#32 of 47 Old 09-25-2007, 05:44 PM
 
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What does "overall chance of fetal death in a VBAC labor" mean? Is that the general risk of vaginal birth vs. just uterine rupture? Is that number given to put the other number in perspective? If this is just the vaginal birth neonatal death rate, then would the "overall c/s death rate" be ALL neonatal c/s death rates? I'm just a little confused about what this means exactly. It seems to contradict other studies showing neonatal death from c/s to be many times that of vaginal birth.

I found information recently that the risk of death from UR is .046%. This is not far off from the projects' stats of 0.06%.
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#33 of 47 Old 09-25-2007, 07:06 PM - Thread Starter
 
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What does "overall chance of fetal death in a VBAC labor" mean? Is that the general risk of vaginal birth vs. just uterine rupture? Is that number given to put the other number in perspective? If this is just the vaginal birth neonatal death rate, then would the "overall c/s death rate" be ALL neonatal c/s death rates? I'm just a little confused about what this means exactly. It seems to contradict other studies showing neonatal death from c/s to be many times that of vaginal birth.

I found information recently that the risk of death from UR is .046%. This is not far off from the projects' stats of 0.06%.
yes, the 6 in 1,000 in the VBAC death rate. i didn't ask whether that was neonatal or perinatal... i'm guessing neonatal. i'm having an awfully hard time finding more info on this. i also don't know if that's all risk groups or what. the fact that it is 2x the neonatal death rate for c/s doesn't surprise me--seems to be in line with the body of literature on VBAC vs. c/s. what does surprise me is how HIGH both these rates are. i've seen VBAC studies where the c/s neonatal death rate is closer to 1 in TEN thousand. so, i'm pretty shocked at 3 in ONE thousand.
the VBAC death rate also seems higher than what i've seen in other studies. usually, it's more in the range of 1 to 3 per thousand (for low risk women, i think). just a bit higher than any first vaginal birth, usually. but 6 in 1,000? if my baby had a 1 in 166 chance of dying at my hospital, no way would i VBAC. i'm not interested in a repeat C with a 1 in 333 chance of neonatal death either.
i wish i could find out more about this project. anyone know anything?
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#34 of 47 Old 09-25-2007, 10:03 PM
 
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Do they have a source for their numbers?
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#35 of 47 Old 09-26-2007, 12:12 AM - Thread Starter
 
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the beginning of the handout says "This document was created by obstetric doctors, midwives, and nurses from hospitals across Vermont and
New Hampshire. It is based upon thorough and thoughtful review of medical studies of VBAC. It is a collection of everyone’s understanding of these studies."

and it lists just Mozurkewich, Hook, and Levine as footnotes.

so, i was initially thinking that these were their results, but i guess they're just the project leaders' summation of the existing literature. the project, btw, has apparently been successful in getting smaller, rural hospitals that had previously banned VBAC to offer it again. so, that's good. the ACOG recognized the people involved with it and gave them some kind of award. that's pretty much all a google search on it turned up.
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#36 of 47 Old 09-26-2007, 11:29 AM
 
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I didn't post it in this thread since it wasn't on topic but since things have swung round a bit to research... if you're doing in-depth research and don't mind having to locate the full study through your library or a subscription database...

Check out http://www.worldserver.com/turk/birt...bac2005-9.html You've probably already been there, but this site lists much of the VBAC research that's been published (pro-vbac, con-vbac, undecided-vbac, etc) and it has an international perspective (so some studies may not be available in english). It provides the citation info and an abstract of the research/findings. It's not exhaustive, but combined with a search of something like PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez) you'll have a fairly good representation of national and international findings.

On a related note, there is a study in the works that is going to be a random controlled study of c/s and vbac. It's unique in that women will be randomly assigned to vbac or repeat c/s at 38 weeks. I'm very interested in seeing how they control for other factors (and which ones they choose to address) and what their results will be. But it's probably going to be another year or two before the study ends and the data is published.

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#37 of 47 Old 09-28-2007, 02:08 PM
 
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After reading this entire thread, I'm still not sure what I'll do:
I really don't want another c/s but my 1st birth experience was so traumatizing (56 hours of labor with just about every device shoved in my yoni ), I just don't know if I can go through that again.
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#38 of 47 Old 09-28-2007, 02:46 PM
 
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You know, the choice doesn't really need to be as black and white as "vbac" or "repeat surgery"...

I talked a lot with my fabulous OBs about this... how I really wanted a vbac but was scared that my first birth would repeat itself and I'd have another unwanted c/s on top of another horrible labor. Long story short my first babe had an abnormally large head, she was OP, and she was asynclitic. My water broke on it's own a day before contractions began. I got to the hospital at 5cm, reached 7cm quickly, and then stayed at 7cm despite everything we tried. After 32 hrs of excruciating back labor we tried drugs and then the c/s. I was a wreck.

Basically my OBs said each birth is unique. They also said that IF this birth started to follow the pattern of my last birth they would bring in a portable u/s machine to check dd's position/head size and that there was no reason I couldn't opt for a surgical delivery if the info we got then wasn't what we wanted to hear.

I also made a deal with myself...if I was having contractions but not making progress at any point during my birth I'd give it 5 hrs and then go to c/s. I couldn't stand the thought of having a long labor ending in another c/s. I needed to either progress (didn't care how slowly, any progress would do) or go for c/s and I felt 5 hrs with no progress was about all I'd be good for. Turns out my birth was 12 hrs total from 1st "maybe contraction?", closer to 9 hrs total from "water breaking". But the thing is, I had a backup plan that I had thought out, a c/s backup birth plan, and I had a mental scenario I was comfortable with. "I can do X but not Y. I will ask for Q and then R and then P. I will tell people F and then S and then ask for B." and so forth.

A vbac requires IMO a lot more dedication and trust than a non-vbac birth just because you know what can go wrong and you know that "bad things happen to good people" so to speak. A vbac mama often has birth trauma on top of all the normal angst and that's important to acknowledge. Give yourself permission to birth and permission to change your mind if necessary. And find people who support you 110% no matter what.

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#39 of 47 Old 09-29-2007, 01:29 AM
 
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Originally Posted by wombatclay View Post
You know, the choice doesn't really need to be as black and white as "vbac" or "repeat surgery"...

I talked a lot with my fabulous OBs about this... how I really wanted a vbac but was scared that my first birth would repeat itself and I'd have another unwanted c/s on top of another horrible labor. Long story short my first babe had an abnormally large head, she was OP, and she was asynclitic. My water broke on it's own a day before contractions began. I got to the hospital at 5cm, reached 7cm quickly, and then stayed at 7cm despite everything we tried. After 32 hrs of excruciating back labor we tried drugs and then the c/s. I was a wreck.

Basically my OBs said each birth is unique. They also said that IF this birth started to follow the pattern of my last birth they would bring in a portable u/s machine to check dd's position/head size and that there was no reason I couldn't opt for a surgical delivery if the info we got then wasn't what we wanted to hear.

I also made a deal with myself...if I was having contractions but not making progress at any point during my birth I'd give it 5 hrs and then go to c/s. I couldn't stand the thought of having a long labor ending in another c/s. I needed to either progress (didn't care how slowly, any progress would do) or go for c/s and I felt 5 hrs with no progress was about all I'd be good for. Turns out my birth was 12 hrs total from 1st "maybe contraction?", closer to 9 hrs total from "water breaking". But the thing is, I had a backup plan that I had thought out, a c/s backup birth plan, and I had a mental scenario I was comfortable with. "I can do X but not Y. I will ask for Q and then R and then P. I will tell people F and then S and then ask for B." and so forth.

A vbac requires IMO a lot more dedication and trust than a non-vbac birth just because you know what can go wrong and you know that "bad things happen to good people" so to speak. A vbac mama often has birth trauma on top of all the normal angst and that's important to acknowledge. Give yourself permission to birth and permission to change your mind if necessary. And find people who support you 110% no matter what.
: Thank you so much for this. Reading it made me feel a lot more comfortable and in control.
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#40 of 47 Old 09-29-2007, 11:54 AM - Thread Starter
 
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wombatclay-
yes! this is where i was trying to go with this whole thread.

DH and i have spent a lot of time talking about this lately. my thoughts of the moment are that i won't even make a decision until around 35 weeks. if, at that point, things look good for a VBAC for me, then i think i'll go for it. one big dealbreaker for me is another unstable lie--DD was transverse until 36 weeks, then OP, and i think her late turn had something to do with her cord troubles. i know there's a big correlation between breech/unstable lie and problems.

another thing i do no want to endure again is a wonky heartrate in labor. the thought of watching it drop again and again is too much. however, i think my OB will feel the same way, so i'm not too worried there.

my big hangup right now is whether i'll get the epidural or not if i do VBAC. does anyone know how willing they are to insert the epidural cathether and not medication? i really hate the idea of general anesthesia for a birth.

this might all change 10 times in the next 8 months, of course.
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#41 of 47 Old 10-06-2007, 09:58 PM
 
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Hi everyone. I'd like to join too. At times I'm positive I want a VBAC but other times I doubt myself. It's not an easy decision to make. I had my first child vaginally but my second via c-section due to complete Placenta Previa.

I would like to due a VBAC this time if possible. Honestly though and I hope no one throws : at me - my c-section was much easier for me than the traumatic birth of my first DS. Even recovery was easier. (Plus the hospital was great in allowing me to have the baby right away, stay with me and DH in recovery, room with me after the first night but the baby was with me most of that first night anyway, etc.) I think because I knew that anything but a c-section wasn't an option for me I don't have any emotional scars because of it. At first I was devastated about the c-section, but maybe because I had a 'good' experience, I've come to terms with it.

I want a VBAC this time because I know it's better for me and the baby. I'm not afraid of a c-section, but I am afraid of tearing like I did with my vaginal birth. My labor was fine with DS1 but the actual birth was very tough for me. It was positive in the fact that I had a baby and we were thankfully both healthy, but that was about it. I'm ashamed to say that but it's true. It was not the birth experience I had visioned, but neither was my c-section come to think of it.

Of course there are no guarrantees that another c-section would be as easy as my first and that a vaginal delivery would be as bad an experience as I had either. That makes it so hard to decide.

One note, just because you have a scheduled c-section doesn't always mean that is when the baby is coming! I ended up having a semi-emergency c-section due to the fact that my bleeding from the previa was getting to a point that the doctors weren't comfortable with it. Plus I was contracting, and had a short labor with my first, so the risk of going into labor and hemorrhaing was valid. I ended up having Holden a week before I was "scheduled."

Thanks for all of the insight and information everyone. I really appreciate it.

I hope my placenta isn't low this time. Last time it started out low and just kept getting lower. I must have had a communication lapse with my placenta, for some reason it went the opposite of what I told it to do!

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#42 of 47 Old 10-06-2007, 09:59 PM
 
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oops, forgot to subscribe.

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#43 of 47 Old 10-09-2007, 03:59 PM
 
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I am currently going through the same thing. I am 10 weeks preg with my second child. My fist son is 13 months old and was born via c-sec due to being breech. The delivery was scheduled, but I went into labor on my own and was contracting and dialated to 4cm and everything before we got into the OR. I am now having problems finding an OB who will do a VBAC. My insurance does not cover and midwives in my area. My current OB plainly said "NO" to a VBAC.
At first I was crushed, cried and got very upset. I still would really like to VBAC. But it seems as if the decision is being taken out of my hands. I am definatly not up for the option of a homebirth (I'm too much of a chicken). I don't know what to do.
After I calmed down a little, I think I am starting to make peace with the fact that I will most likely have to have a repeat c/sec. My first delivery wasn't horrible. I don't like the idea of recovering from another surgery though. I'm not sure. I also dont know how I feel about the "labor at home until ready to push" plan either, I live and hour away from my hospital.
Emotionally, I keep going back and forth. What if something happened? What if I am that 1%? Could I live with myself, if something happened to my baby because I insisted on a VBAC against my doctor's advise? I just dont know waht to do. I also dont know if I really have any options here.
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#44 of 47 Old 10-09-2007, 08:01 PM - Thread Starter
 
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sstrezo, that just seems so unfair that your OB can make the decision for you. did she say why? are you far from a hospital that does VBACs?

i just met with my OB (a new one, my old OB doesn't deliver babies anymore but she was honestly the best OB in the world, in my humble opinion
this new one was so calm and optimistic about VBAC. she didn't even ask me if i wanted to schedule it--just talked about my last delivery, how a cord problem was unlikely, and i should have no trouble with a vaginal delivery this time. i told her i was afraid that i wouldn't go into labor before 41 or 42 weeks and she didn't bat an eye, just said of course i would go into labor!

i don't understand how some OBs can be so positive about VBAC while others refuse to attend them. is it a matter of the hospital only? i know my hospital has a fully staffed OR 24/7, is that it?

anyway, it was SO reassuring to hear this OB (who my old OB highly recommended), who delivers at the best hospital in NYC, be so positive about VBAC. i'm sure i'll still panic about it a hundred times before i have this baby, but i already feel more at ease. i wish everyone had OBs like this near them.
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#45 of 47 Old 10-09-2007, 10:02 PM
 
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Well, part of the VBAC debate has to do with ACOG. Basically, until a few years ago the ACOG guidelines for a VBAC recommended that a surgical team to be on call during a vbac attempt. This wasn't a problem for most hospitals (many smaller hospitals provide this sort of on-call care as a routine policy, especially during "off" hours). Then ACOG changed their guidelines to say that a surgical team should be "immediately available" during a vbac attempt. Most facilities (and insurance companies) take this to mean that the surgical team needs to be physically present and "reserved" for the VBAC mama in the event of an emergency. Since medical insurance companies generally wont insure a doctor/hospital that is knowingly providing care that does not meet "industry standards"...well.

Some hospitals got pushed out of vbacs because they simply didn't have the resources (the cost of having a full surgical team standing by "just in case" for and unknown period of time is pricey), and some hospitals used the new guidelines as an excuse to stop offering vbac.

In terms of individual providers, medical insurance companies/malpractice insurance companies charge different rates depending on the types of patients a care provider has. The wonderful OBs I saw for my VBAC stopped attending births shortly after mine since they couldn't afford the insurance necessary to attend the sorts of births they feel are important (natural, unmedicated, vbac, etc).

There are lots of reasons why a specific hospital or care provider doesn't "do" vbac...

Which is sad.

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#46 of 47 Old 10-10-2007, 04:51 PM
 
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OK, so I am starting to have some more hope!!!! I recently found a doctor's/midwives group in willowbrook, IL called West suburban Women's Health. I called and the nurse said that they absolutly do VBACS!!!!!!!I explained my current situation and told her about my problems with my current OB and with finding another who would do one. She was shocked that so many offices were flat out refusing to even consider it. She did mention that she believed it was because of the medical malpractice insurance waivering doctor's opinions. So, I am just waiting for the scheduling lady to call me back to make an appointment. I am so happy that I could just cry!!!!!!!!: I know not all planned VBACs end in a vaginal delivery, but at least I know I have that choice and at least I know that I will have put in the full effort. So for anyone in the south chicago area looking for a VBAC friendly OB, it sounds like West Suburban Women's Health just might be the best option. I will keep posting.
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#47 of 47 Old 10-13-2007, 11:29 AM
 
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One of the major reasons that we (my DH and I) feel VBAC is right for us is because it is so much safer for moms and we haven't found any true contraindications for the baby either. I already have a beautiful little girl who depends on me and I love her with all my heart so I have to take care of myself for her. I have to be here for her. -Iris
I just read this and looked at my little guy and cried and cried... I have never thought of VBAC in these terms before - thank you.

I also wanted to say I cheer all of you on in your decision making and am proud of you whatever you decide. It's a lot of work to make informed decisions not based on fear - and sometimes it makes us cry

I am 10 weeks now and slogging my way through all of research and opinions. I am lucky in that when I went into my OB's office my MW said we love VBACs!
I wish you all knowledge without fear and peace.
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