The VBAC Dilemma
By Alaina Kerkhove, Vice Chair, SDSCO
Surgical births (c-sections) are at an all time high of 32%. Consequently, more and more couples find themselves in the position of having to decide if they should have a repeat cesarean or attempt a VBAC, vaginal birth after a cesarean. It is getting increasingly difficult for these families to find a care provider willing to even consider the VBAC option, and for women who have had two or more surgical births it is almost impossible to find a care provider to work with them.
In the 1960s the c-section rate was under 5%. After hospitals began using routine fetal heart monitoring, the c-section rate more then doubled with no better outcomes. The 80s brought a time of reform: mothers demanded VBACs. According to the National Vital Statistic Reports, the VBAC rate hit an all-time high in 1997 of about 28%. In 1999 ACOG (American College of Obstetrics and Gynecology) came out with the recommendation that “VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care." This recommendation caused many hospitals to refuse to do VBACs and other hospitals to tighten their restrictions. The result is an out-of-control c-section rate that has been climbing every year with no better outcomes. The studies are very clear that vaginal birth is safer for moms and babies, and the risks with c-sections increase with each surgery the mother undergoes. We should be outraged that one out of 3 babies is born through major surgery.
According to “Open Letter to Christiana Aguilera” by Jennifer Block, author of the book Pushed, “…women report longer, more grueling recoveries and more lingering abdominal pain following a cesarean. You're also going to lose more blood during surgery -- twice as much as you would with a normal birth (if you were birthing vaginally, this blood loss would qualify as a hemorrhage!) Aside from the risks of the surgery itself (infection, organ damage, anesthesia complications, etc.), you're also setting yourself up for a higher risk of future reproductive complications, even if you decide on another cesarean. Babies who are born without labor, including babies born by scheduled cesarean, are more likely to have respiratory troubles, which means they're more likely to end up in an incubator in intensive care, which means they have less contact with mom. Perhaps this is why an enormous study of U.S. births found that cesarean babies are more likely to die within the first three months of life.”
What is creating this surge of c-sections? In the movie Born in the USA experienced physicians tell younger doctors, “If in doubt just section them. They can’t sue you if you section them.” Besides being a protection against lawsuits for doctors and hospitals, cesareans are also big business. The U.S. Agency for Healthcare Research and Quality in 2003 puts the cost for an uncomplicated c-section at $5,300 dollars more per birth then an uncomplicated vaginal birth for just the hospital costs.
I have had the opportunity in the last six months to visit with several moms about their journey to be able to have a VBAC with a care provider. They all had to travel long distances to even be considered for a non-invasive VBAC. Some had doctors who refused to see them, while others had doctors walk out on them. They all had conditions put on them to determine whether or not they would be allowed to give birth vaginally at the time of their due date. One mother said, “They put so many restrictions on me I didn’t believe that they had faith that I could give birth vaginally.” These mothers’ pregnancies were filled with undue stress trying to achieve what they knew was safest for them and their babies. This journey did not end at the birth of their children. For those who had repeat c-sections and even for those who also had given birth vaginally, the healing and the processing still continues.
What are we as consumers able to do? My first recommendation would be to do everything in your power to avoid a surgical birth in the first place. Some ways to do this are by carefully choosing your health care provider, one that will let you move around in labor, eat, drink, take a bath, etc. Take responsibility for your birth by educating yourself about pregnancy, labor, and birth. Also, hiring a doula has been shown to reduce cesareans.
For those who have already had a c-section, I was told by a CNM that parents just need to demand VBACs. Parents need to complain to the doctors and hospitals in writing. Join or start an ICAN group (www.ican-online.org). Consumer demand has been one of the driving forces to change hospital policy. We need to continue to be actively voicing our concerns and desires in order to create changes that will increase safety and reduce cost while increasing dignity and
respect for all families.
According to “Open Letter to Christiana Aguilera” by Jennifer Block, author of the book Pushed, “…women report longer, more grueling recoveries and more lingering abdominal pain following a cesarean. You're also going to lose more blood during surgery -- twice as much as you would with a normal birth (if you were birthing vaginally, this blood loss would qualify as a hemorrhage!) Aside from the risks of the surgery itself (infection, organ damage, anesthesia complications, etc.), you're also setting yourself up for a higher risk of future reproductive complications, even if you decide on another cesarean. Babies who are born without labor, including babies born by scheduled cesarean, are more likely to have respiratory troubles, which means they're more likely to end up in an incubator in intensive care, which means they have less contact with mom. Perhaps this is why an enormous study of U.S. births found that cesarean babies are more likely to die within the first three months of life.”
What is creating this surge of c-sections? In the movie Born in the USA experienced physicians tell younger doctors, “If in doubt just section them. They can’t sue you if you section them.” Besides being a protection against lawsuits for doctors and hospitals, cesareans are also big business. The U.S. Agency for Healthcare Research and Quality in 2003 puts the cost for an uncomplicated c-section at $5,300 dollars more per birth then an uncomplicated vaginal birth for just the hospital costs.
I have had the opportunity in the last six months to visit with several moms about their journey to be able to have a VBAC with a care provider. They all had to travel long distances to even be considered for a non-invasive VBAC. Some had doctors who refused to see them, while others had doctors walk out on them. They all had conditions put on them to determine whether or not they would be allowed to give birth vaginally at the time of their due date. One mother said, “They put so many restrictions on me I didn’t believe that they had faith that I could give birth vaginally.” These mothers’ pregnancies were filled with undue stress trying to achieve what they knew was safest for them and their babies. This journey did not end at the birth of their children. For those who had repeat c-sections and even for those who also had given birth vaginally, the healing and the processing still continues.
What are we as consumers able to do? My first recommendation would be to do everything in your power to avoid a surgical birth in the first place. Some ways to do this are by carefully choosing your health care provider, one that will let you move around in labor, eat, drink, take a bath, etc. Take responsibility for your birth by educating yourself about pregnancy, labor, and birth. Also, hiring a doula has been shown to reduce cesareans.
For those who have already had a c-section, I was told by a CNM that parents just need to demand VBACs. Parents need to complain to the doctors and hospitals in writing. Join or start an ICAN group (www.ican-online.org). Consumer demand has been one of the driving forces to change hospital policy. We need to continue to be actively voicing our concerns and desires in order to create changes that will increase safety and reduce cost while increasing dignity and
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