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Discussion Starter · #1 ·
This is mostly just a vent - drives me crazy what docs tell their patients!<br>
Was just talking to an ER doc colleague who is pregnant with #2. Her OB group is telling her that there is "new information that shows VBAC isn't safe" and she has to have a c-section for #2. Her first cesarean was for "failure to progress." Her membranes ruptured spontaneously and they started pitocin after 8 hours. She didn't dilate past 3, so she had a cesearean. (Care to comment stafl?) It sounds like they did wait 24 hours total, though.<br>
I told her she's a doctor, she can do her own research, and that in my practice I would consider her having an excellent chance of successful VBAC! I told her to check out the "new research" herself, since to me it just confirms that VBAC remains quite safe when labor is un-induced or augmented.
 

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I've actually been hearing that a lot from other c/s moms lately. I'm really curious as to where this new research is?
 

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Discussion Starter · #4 ·
There are actually several large VBAC studies published in about the last 3-4 years. They actually confirm earlier data that suggest a uterine rupture rate of about 0.5% (This is all types of rupture - including assymptomatic scar openings that may be seen at a subsequent cesarean) One study showed that VBAC induction by prostaglandins had a much higher rate of rupture - about 7.5%, or about 15 times higher than the rate for spontaneous labor. The data has really not changed all that much in the time VBACs have been regularly planned.<br>
What has changed is the general obstetric feeling towards them. The first big recent study, the one that showed the higher rate of rupture with prostaglandins, was published in the New England Journal in June of 2001. It's accompanying editorial for some reason stated that clearly repeat cesarean is the safest option. ACOG then followed suit by stating that VBACs should only be allowed in hospitals with 24 hour in house OB and anesthesia. More and more docs started to decide it wasn't worth it to sit in house with a VBAC patient, or risk being sued if something happens. Some hospitals decided to stop VBACs altogether (a scheduled c-section can be planned during regular working hours.)<br>
All that has changed is attitude. VBAC with spontaneous labor is no more dangerous today than it was 10 years ago. And women are being forced into repeat cesareans because they can't find anyone to assist them to VBAC
 

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I would say that the new vbac study done by the NEJM that came out this month DID confirm how SAFE vbacs are! (Is one of the studies that you are referring to doctorjen?)<br>
Hopefully ACOG will change their guidelines again to encourage vbacs. Doesn't hurt to hope right?<br><br>
doctorjen, hopefully this collegue of yours will take your advice. I don't know what studies those drs [who discouraged her] looked at, but they are obviously false!<br>
*btw, it is nice to "meet" you. I have seen you on other threads b4 but I think this is the first time I replied to you.<br><br>
To share in your vent -- one of my biggest peeves is when women show an interest to vbac and are given the false or MISinformation and then, there goes their interest...<br><br>
IRL, a gf of mine had a c/s last Aug (that's a whole other vent!) and when she went to have her stitches removed, she asked her dr if she could have a natural birth next time. His answer "No. It is too dangerous." <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">: He would have gotten an earful if I was with! This gf is one that would do everything her dr says BUT hehe I am gonna do my best educate her otherwise!
 

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Care to comment stafl?</td>
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actually, my c/s was because Jenny's heartrate dropped to TEN beats per minute after I was given Cytotec... but other than that, yeah, sounds just like my story. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/angry.gif" style="border:0px solid;" title="angry"><br><br>
Yeah, she is a perfect candidate for VBAC!! Why isn't she doing her own research???
 

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I always find it odd how DR always have different opinions on everything it seems! My OB offered a VBAC to me before I even brought it up. I think he was a little surprised I took him up in it (he probably remembers me going on and on before my c/s w/ AJ how I was never having kids again <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> ). He was incredibly supportive the whole time and besides wanting me in a hospital w/ 24 hr everybody, had no restrictions or anything. My VBAC consent form even starts out by saying VBACs are safer than ERCS by a long shot! Long story short, my ctxs started on their own and 12 hours later I had my VBAC I so wanted and it was wonderful!
 

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I get so cross about this rubbish too. And with the internet there is so much good, reputable, references information about but so many of us still believe the nonsense that got us our first c-sec. It's tragic!<br>
J
 

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Yeah, I have heard the same thing from several OB's in town. Most of them think alike it seems. For a while, many were pro, and then the tide turned.<br><br>
I do understand why some, especially in practice by themselves or in very small groups, feel that they cannot labor sit for every woman who wants a VBAC. They cannot just cancel all their patients for a day and hang out, right? I think that is the main problem with women not being offered VBAC's by their OB's these days. I feel that most of the blame should go to ACOG and the subsequent shift in hospital policies that requires the labor sitting. Plus, they get sued all the time for bad outcomes, and if they do not follow the official policy than they are at risk.<br><br>
But they can't honestly tell the woman "Look, I can't do it because the policies are too restrictive". Instead, it is all about scaring women and making them think that surgery is the safer option.
 

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<div style="font-style:italic;">Her first cesarean was for "failure to progress." Her membranes ruptured spontaneously and they started pitocin after 8 hours. She didn't dilate past 3, so she had a cesearean. (Care to comment stafl?) It sounds like they did wait 24 hours total, though.</div>
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OMG, that sounds a lot like my experience. My membranes ruptured at 12:30 am, and I finally let them give me pitocin at 7 pm when I was at 5 cm. By 11 am the next day, I was at 7 cm, and had been for 9-10 hours. My OB said that a c/s was the best thing at that point even though Silas was showing no distress signs and I was fine, but I was exhausted after being up since 7 am the day before my water broke, except for a mild 3 hour nap after finally "giving in" and getting some nubain. So, I was in labor for 36 when they wheeled me into the operating room.<br><br>
I really am going to push hard for a vbac. The hard thing will be finding a doctor in my area who is supportive.<br><br>
Tiffany<br>
Silas, 10.21.02
 

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I'm hearing that, too, Jen. I'm wondering if there is more fear based stuff being talked about (nothing scientific, mind you) and put out there to quiet those docs/CNMs that are angry about the no-VBAC policies of many hospitals. ?<br><br>
It just seems like suddenly, there's all this "new" information about how VBACs are soo unsafe, whereas for the last 20 years, it's been realtively positive and safe. Hmmm....
 

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Doctorjen, it might help more if you actually *give* her copies of the studies, so she can look at them herself (harder to "forget" to do it that way...) Yeah, it's interesting to look at study design and the actual statistics.<br><br>
My ob was totally fine with having to "be there" while I was in labor. There were other women from the clinic there having babies, so it wasn't just for me. And their office is literally just down the hall from the birthing wing of the hospital... so during the day, the on call dr. is "in the hospital" when she's attending patients in the clinic as she normally would, and at night, I think they just hang out in their offices catching up on paperwork. (Honestly, yes, I think the design of the new hospital--which includes ob practices under the same roof--helps them offer vbacs.)
 

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I was all set to go with a midwife for a VBAC, when I met an ob who told me about the NEJM article on VBACs. The ob knocked my socks off when he pointed out that in his opinon, the problem with the article wasn't its conclusions about VBACs - he thinks they're great, and has a 60% success rate with them - but that there were three maternal deaths in the C section group. He said that it was disturbing to him that the analysis section of the article didn't take the deaths as a moment to reexamine the safety of c-sections.<br><br>
Needless to say, we're using this guy for our VBAC! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up">
 

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I'm a little confused. If a hospital won't allow VBACs because someone has to be present throughout the labour, does that mean that nobody has to be present for a normal labour? My first cesarean was done in an absolute frenzy of panic, because I was almost completely dilated, and the baby was breech (I had stayed home in labour for about 20 hours before going to the hospital). If that section was really necessary (and it's been almost 12 years, so I don't think I'm going to try second-guessing them at this point), then how is it any more dangerous for me to be at hospital for a VBAC?<br><br>
As far as the doctors are concerned, I absolutely required an immediate emergency c-section in 1993. If it's not safe for me to VBAC at the hospital, then it seems to me that it wasn't safe for me to have my first baby there, either.<br><br>
I wonder how long it's going to be before the OB/GYN community as a whole comes down with official recommendations to do all deliveries by routine section? They seem to be in love with cutting moms open.
 

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i birthed my son vba2c in the hospital 19mos ago. No one was present during my labor cept dh and my personal labor coach/friend/pseudo doula. Midwife showed up in time to get on a glove and help catch.<br><br>
odd.
 

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Discussion Starter · #17 ·
I agree that a hospital where it isn't safe to VBAC is probably not safe to have any baby at. If the hospital isn't prepared to react to a uterine rupture, they probably aren't prepared to react to any emergency. Drives me nuts to hear all these precautions for VBACs, without similar care taken for every mama and baby.
 

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I wasn't 'labor' sat either. I went to the hospital at 3am, I was lucky DH was w/ me! lol
 

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"If it's not safe for me to VBAC at the hospital, then it seems to me that it wasn't safe for me to have my first baby there, either."<br><br>
That sentiment is on ICAN's website, did you know that?<br><br><br>
As for labor sitting, does anyone ever watch old Cosby Shows and get wistful when they show him taking SUCH amazing care of his patients? There was one where he couldn't go to an awards ceremony at which he was being honored, because a patient was in labor and he wanted to be there with her while she labored.<br><br>
I'm about 90% pro-UC and 10% for the right midwife, but if there were a Dr. Huxtable around, I'd consider him too. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngtongue.gif" style="border:0px solid;" title="Stick Out Tongue">
 

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Discussion Starter · #20 ·
I think it would be great for all docs who attend births to truly labor sit. In practice, they are usually in the hospital somewhere, probably on the internet or sleeping, waiting to be called when the head is showing - or popping in and out of the room wondering what's taking so darn long and stirring up problems.<br>
Sitting with women in labor is one of the great privileges of my job, I think. It amazes me how strong we are! I attended an awesome VBAC about 2 1/2 weeks ago. The mama arrived with ruptured membranes, just 1 cm dilated. She had taken a Bradley class, and planned and prepared for an unmedicated birth. I think she was literally overwhelmed by her powerful labor to start - and it was so amazing to watch her learn to cope with it. She went on to push out her gorgeous 8 lb baby girl without a pain med or a vaginal exam after admission. My big contribution was to sit in the room sewing, and reassuring her that all was normal. Then in transition and pushing, I took turns with her MIL fanning her and getting new cold cloths for her face. We joked later that this mama's favorite word in labor was "OW!" because she chanted it at the peak of each contraction, which worked well for her. Most docs don't get to, or at least take the opportunity to, labor with a woman. Instead, they walk into a room where someone is chanting "OWW, OWW, OWW" and start ordering pain medicine.
 
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