How much is the uterine rupture rate for VBACs downplayed by ICAN? - Page 2 - Mothering Forums

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#31 of 39 Old 02-22-2004, 05:09 PM
 
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I'll jump in again...

When I evaluate numbers (aka "statistics"), I like to be able to see the source--know how the study was conducted, how big the sample size was, check out what kind of statistical tests they do, etc., because I'm pretty comfortable with the mathematical field of Statistics... not all numbers are created equal, y'know. However, it's not really realistic for non-medical person me who no longer has access to tons of scientific literature to try to get these papers in the first place, let alone read them. But when a bunch of studies are coming out with similiar numbers (~0.7% UR for LTCS, 5-10% for classical, and various high and scary numbers for pitocin and prostaglandins), I find them pretty credible.

That said, it *is* hard to figure out how it applies to oneself. Let's see... I have a LT incision, and I'm a normal weight, but I'll probably have a "big" baby and I'm over 30. Two of the OBs at my practice are quite supportive of my desire for a VBAC, one is more hesitant (and one is thankfully out of the picture).

ICAN and birth activists are trying hard to prevent "unnecessary" cesareans, but in many cases, it can be very difficult to determine how necessary a cesarean was. And it does help to make a mother feel bad about herself after the fact. Doctors and hospitals are very conservative about VBAC, often to the point of refusing to do them, even when a woman is "qualified" for one and wants one, due in part to a belief that they have more control when they do repeat Cs and in part due to fear about lawsuits (and they never seem to compare the risks of VBAC and the risks of repeat Cs).

Caught in the middle are women who are trying to do the best they can with sometimes confusing information. We have to try to remember these individual women and not marginalize them in this struggle.

(I don't want to speak for Ladylee, and I'm sure she'll correct me if I'm wrong, but I believe she didn't have access to a VBAC.)
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#32 of 39 Old 02-22-2004, 05:11 PM
 
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Quote:
Originally posted by pamamidwife
Well, it's fine to personalize what you want for yourself. However, to make blanket statements that insinuate that an organization is purposefully lying to women and thereby endangering them is inappropriate.


The true risk of VBACs is a legal system that has pushed a medical system into so much fear that it has long left evidence-based medicine.

And that is hardly downplaying the situation.

I'm merely asking for fact that ICAN downplays the rupture rate.

On ICAN mailing lists and groups they make it sound like it will NEVER happen to you. That ruptures are just so far out in left field you are not going to be one of the ones who ruptures. I read the Silent Knife and multiple VBAC books, hardly any of them cover actuall ruptures. They only discuss a percentage, how low it is, and that I more likely to get murdered or hit by car. Why not discuss actual ruptures, women who have experienced thier babies dying, women who have lost their reproductive organs becaue they ruptured. No that is taboo. Dont talk about it because it is so unlikely to happen to you but god knows if someone wants to talk about their HBAC then lets applaud them and say WOO HOOO. I am sorry, but there is not two sides really presented.
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#33 of 39 Old 02-22-2004, 05:20 PM
 
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By the same token, ACOG should really get into the risks of elective c/s, but they don't. They maintain a c/s is the safest way for a baby to be born. In ACOG publications, they make it sound like the serious consequences of a c/s will never happen to you. You'll be on your feet in 8 hours, not need any medication after 3 days, and "definitely have the edge in sitting," according to books like What to Expect (endorsed by ACOG.) Quick and easy recoveries are not as common as they would like you to think. They also point out that having a scheduled c/s allows one to "relax and enjoy the birth."

The ACOG website even says that although Pitocin increases the risk of rupture, it's "not a contraindication" for a VBAC.:

And their ethics committee decided it was ethical to perform a c/s when no medical reason was present. (I would have loved to be in on that discussion...: )
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#34 of 39 Old 02-22-2004, 05:22 PM
 
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Quote:
Originally posted by LisaG

Kim, it sounds to me like your problem with ICAN was lack of support for your decision than thinking they fudge numbers? Not wanting to speak for you, but that was the gist of what I got. As well as feeling that the numbers do not reflect the frequent interventions that occur and that that should be taken into consideration? To me that sounds vastly different than saying that ICAN downplays the uterine rupture rates for VBAC.

LisaG
I think Ladylee and Lisa are getting the gist of what I am saying. I didnt say that ICAN fudged number, I said they down play the risk of rupture and they dont tell that side of it.
I have heard of more than one or two ruptures with VBAC or even before birth so its not so uncommon. I mean lets say roughly it is 1% that you could rupture, why not give an actual number like 10 or 500 or 1000. Why not spell it out that say XXXX number are going to rupture and XX number of babies are going to die because of it and XX number are going to lose their reproductive organs, instead of say 1%.
My mother had a very rare type of cancer and frankly when doing research on it, and I did extensive research, I wasnt just looking at percentages, I was looking at real live human beings, their experiences, etc. I really didnt give a rats behind that less than 1% of the worlds population got this cancer, I wanted to know treatment plans, remission rate, death rate.
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#35 of 39 Old 02-22-2004, 05:44 PM
 
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Quote:
Originally posted by Greaseball
By the same token, ACOG should really get into the risks of elective c/s, but they don't. They maintain a c/s is the safest way for a baby to be born. In ACOG publications, they make it sound like the serious consequences of a c/s will never happen to you. You'll be on your feet in 8 hours, not need any medication after 3 days, and "definitely have the edge in sitting," according to books like What to Expect (endorsed by ACOG.) Quick and easy recoveries are not as common as they would like you to think. They also point out that having a scheduled c/s allows one to "relax and enjoy the birth."

The ACOG website even says that although Pitocin increases the risk of rupture, it's "not a contraindication" for a VBAC.:

And their ethics committee decided it was ethical to perform a c/s when no medical reason was present. (I would have loved to be in on that discussion...: )
I actually dont think the risks of a surgical birth are downplayed, I was aware and informed of the risks. I had to sign a document saying I could die, my child could die, I could lose my uterus, I could get a PE and have a stroke. Etc. However with all I know, I do believe that my surgical birth was safer than a VBAC for ME. And for many reasons.
While I am not a fan of the ACOG I do support the choice and the advice they give on having a planned c/s. I think for someone who has never had a surgical birth to tell women who are planning to have a surgical birth for whatever reason, that they shouldnt schedule it has no idea the emotional aspects we go through to get into that OR and come out. For me, having my csection planned was crucial to my mental and emotional stability. I didn't want any surprises and while things can happen in an OR, I was given a lot of control about my birth I wouldnt have otherwise had, had I gone into labor. And I would do it again and again and again.
I also took measures before, duing, and after my birth to ensure a great recovery. And it was great. I was up and walking around, eating, had no nursing problems, and out in less than 48hours of the hospital. I went home and though I took it easy, I didnt have time to sit on my keister with three children, with two of them bieng under 18 months old. I was driving in a week and had absolute a PAIN FREE recovery. I recovered far better than at least half the women I know that had vaginal births, two that were completely natural births too.
Also the reason most recoveries are not easy and my first one was like going to depths of hell, is that I was in no way emotionally or mentally prepared at all. I was so adamanet that a surgical birth wouldnt happen to me, I was so opposed to it and wanted no part of it that when I was aware of what was befalling me I was devastated. Also I had not bothered to educate myself about any recovery aspects of a surgical birth. None. However I was completely aware of all the horrifying things about csections because I had read the American Way of Birth and Silent Knife and a few others.
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#36 of 39 Old 02-22-2004, 05:49 PM
 
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I didn't get to finish reading the posts here but I really want to point out that one of the biggest reasons for uterine rupture after c/s is CYTOTEC!! One of the other HUGE reasons is single layer uterine stitching. The uterus needs to be stitched at the endometrium and the myometrium. Single layer stitching is cheaper and faster, but it is most certainly second rate healthcare, leading to uterine rupture and possible endometriosis. I will be back to read the rest of the replies as soon as I can!

edited:
I finished reading and I agree with Greasball, what is the incentive for downplaying VBAC risks? There is a HUGE monetary incentive for OBs to discourage VBAC. 1 in a hundred is considered impossible odds, if the uterine rupture rate is .5% - 1% including those induced and those induced with cytotec, then a natural VBAC has negligible odds of rupture. I don't think it's "downplaying risks" I think it's up-playing the safety! Women who have been taught by a violent abdominal surgery that their body is incapable of birthing correctly need a lot of support and information that supports them so they are able to go into labor and birth fearless with more confidence than a primip or a mom who has had all vaginal births.
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#37 of 39 Old 02-22-2004, 11:20 PM
 
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This is a very interesting post for me.
I had a c-sec with my son, i wanted to attempt a VBAC with my daughter...
I reserched VBAC and was seeing a perinatologist, I thought 1% was a low enough statistic for me to feel comftrable to try a VBAC.
We live 4 hrs from the hosp so things went a little diff for me...
I was having contrax and heavy bleeding sun morning, so we decided that it was time to head to the hosp. We got there i was dialated 1-2...we decided to walk...i walked all night and sat on the birthing ball. I did not progress that much, by that evening so my peri decided that it would be best for me to get some pit...not alot just a little to help things along. Mon morning i got pit, from there things seemed to progress very well. By the time i got to 6 cm...i could not stand that pain so i opted for an epidural although it was a very low epi. From there it seemed like things were smooth sailing.
I got dialated to 10, and started pushing i thought YAY im gonna make it.
I started getting this HORRABLE pain on my left side... from there things seemed to go down hill.
There were very conserned because of this pain i was having with the epi...so we opted for a c-sec. I am very thankfull for that decision to this day.
When they cut me open and took Irelend out, they saw that my uterus rutpured...not my scar it was in the middle. thankfully we both survived with everything intact.


I am not trying to scare anyone, i am just stating my story and what happened to me. I am very lucky that Irelend and I are alive today.

I am going on to have a post-rupture baby, this is very scary and we will see in the upcoming months what happens...
i hope and pray every day that things turn out ok, but there is still this negative voice in the back of my head everyday that something is going to happen...

I know that the stats are scary, ruptures happen to alot of people, but there are more people that go on to have happy and healthy VBACS.
My main reason for posting is to tell my story and to say that if you have c-section pain, where you scar is or if you have pain anywhere on your uterus that will not go away go to the dr.


I believe that the 1% stat is correct, if you have any ? feel free to ask.
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#38 of 39 Old 02-22-2004, 11:39 PM
 
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OnTheFence said:
Quote:
I am sorry, but there is not two sides really presented.
This is part of what I was trying to say in my post above... if you want to hear all the bad things about UR and the risk of VBAC, talk to an OB, if you want to hear all the good things, talk to ICAN (or one of the other pro-VBAC sources). And it's not all good and not all bad when you've got this stupid scar in your uterus.

If you're the one trying to make the decision about the VBAC, it can feel kind of wacky, because you have to weigh it all together and decide what applies to yourself/what's best for your own case.

Dawnalex, I'm really sorry about your rupture--it sounded pretty scary. Thank you for sharing your story. I'm glad you can go on to have more kids.
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#39 of 39 Old 02-23-2004, 01:12 AM
 
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if you want to hear all the bad things about UR and the risk of VBAC, talk to an OB, if you want to hear all the good things, talk to ICAN (or one of the other pro-VBAC sources). -KKmama

I like what you have to say, KKmama.

Dawnalex-I'm so glad you are both ok.

OnThe Fence-I hope you keep speaking your truth-it validates others who have had similar experiences (myself included.)
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