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Just home from my second OB apt. and he kept refering to "The McMahan study" done in in Toronto that showed that women VBACing had a 2 and a half time more likely chance of uterine rupture. Anyone know about that study? It's so hard when I keep hearing VBAC is safe and do-able from so many individuals at MDC and then I go to the Doc and get the "risk-basesd" message.

I had a cs in '95 b/c of placenta previa with a bably I planned an adoption for and now am exitedly pg w/ dh. We went to the only OB in our small eastern wa town so we could get an early utra-sound to confirm dates. At that initial exam when questionedd about VBAC he hemmed and hawed and said, "well, let's just see how things go" but he was willing to do it.

Today was our first "real" apt. with the physical exam and I just brought up the VBAC issue again, so that he was sure we're still on the same page. Upon reviewing the operative notes from my CS he noticed that I had both uterine arteries rupture during the procedure and they were tied off. That made him really hit home again on the risks.

He also mentioned Dr. Tom Berenetti (sp?) from University of Washington who's big thing is looking at all the risks of VBAC. Anyone know anything about him?
 

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I'm not familiar with that study but I would ask how many of those women had cervadil (or other drugs to ripen their cervix) and how many had pitocin. Most of those type studies don't necessarily account for that.

I just had my annual with my midwife and we discussed a vbac in my future. The obs in the practice are apparently pro-vbac and give women a counseling statement explaining the benefits and risks of vbacs. My midwife was quick to point out that most UR were from induced labors. She also told me that she had a woman rupture during her 3rd birth and she never had a c-s.
 

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Quote:

Originally Posted by momatheart
At that initial exam when questionedd about VBAC he hemmed and hawed and said, "well, let's just see how things go" but he was willing to do it.
This alone says to me that you should switch providers. From what you write, even before he looked at your records, he wasn't too keen on VBAC, so he found something in your records he could use as "evidence" that you shouldn't try it. My OB said he was for VBAC, but then added a list of complications that would make it so I "wouldn't have a choice." My gut told me that I'd have to fight too hard with him to actually GET the VBAC I wanted. I suggest you look for someone more VBAC friendly.

For the record, VBAC women do have a higher risk of uterine rupture, but moms who have never had a c-section could also rupture, although the risk is lower. But repeat c-sections also have risks (I'll be your OB didn't even mention those!). You can do your own research to ask him about too. But you need to have a provider who will give you both sides of the story. I have no idea if anything in your previous c-section truly does raise your chances of having any additional problems with a VBAC, but you deserve to work with someone who is really in your corner for a VBAC, and then you'll be able to trust them if they DO recommend another c-section. You'll be able to trust that it is truly necessary and not for their own convenience.

Birth is like life: it's a risky enterprise. There are no guarantees, and anyone at any time can have something terrible happen during the birth of their child, even though it is relatively rare. You deserve to have a provider who will discuss the risks with you honestly and not try to scare you.
 

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You really need a good careprovider. A surgeon who quotes one study to you (of the 1000s which demonstrate that VBAC is safer then ERC) is not giving you good care. You can read the studies yourself in dozens of places online and make up your own mind. You really need to buy a copy of "The thinking woman's guide to a better birth" by Henci Goer which has a lot more than one study to back up her assertions! Her chapter on ERC is called "Elective Repeat Caesarean? Just say no!" and that pretty much sums it up. Get yourself a midwife and start getting evidence based care not an arrogant surgeon who only tells you what agrees with his limited belief system and not the evidence.

Quote:
So beware. Surgeons try to sell surgery. Never forget that obstetricians are, after all, surgeons. Women must be extremely cautious in the face of this hard sell and get the facts from those who do not have a vested interest in surgery.
- Marsden Wagner, M.D., M.S.P.H.
 

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Congratulations on baby in womb! And you are such a loving mommy already, wanting the best for you and your baby and you are my hero for adopting out your first baby.
VBAC does have risks, as does a ERC. The important thing is that you are well educated about everything. I joined the ICAN list www.ican-online.org and read, and read and read. I had a successful vbac and now I'm very involved w/ ICAN. Someone there will know about the McMahon study--I seem to vaguely remember a discussion of it. I became very familiar w/ pubmed. I didn't always understand everything in the studies, but I always had someone at ICAN to explain what different terms meant.
I don't know anything about uterine arteries rupturing during a c/s. Someone there will know, or maybe you could post it on the mw forum here. You can also do a search on pubmed.
It may be a matter of interviewing more c/p. I had a tear in my cervix during my c/s and one doc told me I was a horrible candidate for c/s, but then I interviewed 5 others who said no big deal. Then I found the study that said I had a 1 in 200 risk of the scar tissue causing a stenotic (slow opening) cervix.
Keep us posted on your search! pm me if you have questions about ICAN.
 
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