VBAC’s in the media

April 6, 2009 at 10:54 pm (Hospital Procedures, Informed Consent)

While perusing the magazine rack at my local coffee house, I found an article entitled “The Trouble With Repeat Cesareans” in the March 2nd edition of Time magazine.  I’d recommend reading it in full, but I’ll share a few details.  I find it heartening that a national publication is covering the difficulty many American women are having in completing a successful VBAC. 

“Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them.” (emphasis added)  This an important point for both first-time mothers and those who are pregnant after a Cesarean.  Many physicians consider it their duty to restrict a mother with a previous C-section to a surgical delivery in subsequent births.  During research on the rights of informed consent and refusal, I stumbled on a discussion between physicians about “those women” who try to deny C-sections when their practitioners refused to attempt a VBAC.   A lone doctor (immediately one of my heroes) argued that, ultimately, it is a woman’s choice what is done to her body.  He acknowledged the ethical dilemma faced by a doctor who truly thinks a C-section is the safest option, but concluded that if a mother refused one, it was his duty to attend her vaginal birth and usher her through it as safely as possible.  This was not the opinion of most of the other doctors in the discussion, however.  They lamented the VBAC movement and discussed tactics for convincing a woman to have surgery, regardless of her wishes.  To them, informed consent meant doing something because your doctor had informed you it was the right choice, and informed refusal was something to be dismissed with ever-more-dire predictions of disaster if their recommendations were ignored.  I don’t know how many OB’s similarly discount the right of birthing women to determine their own decisions regarding medical care.  I do know that, if a woman wants a VBAC, in many areas around the country she’s fighting an uphill battle, and she should come to the birthing suite armed with information and a doula (our nurturing and comfort techniques have been shown in studies to decrease the incidence of Cesarean sections).

The article described the climate that has contributed to the decrease in VBAC availability in the US.  “In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBAC’s because insurance was unaffordable or unavailable; 33% said they had dropped VBAC’s out of fear of litigation.”  Doctors are afraid of being sued if there is a bad birth outcome, and they have been encouraged to believe that VBAC’s are likely to lead to a bad outcome.  But is this really true?  And what are the risks of repeat Cesareans, as compared to the risks of VBAC?

“The risk of uterine rupture during VBAC is real….but rupture occurs in just 0.7% of cases.”  Add to that the fact that uterine ruptures, although they have serious potential complications for mother and baby, are not necessarily fatal to either.   And uterine ruptures can also occur in an unscarred uterus, especially when the mother is given Cytotec to induce her labor (see this article by Marsden Wagner, a reknowned researcher into American birth practices). 

“With each repeat cesarean, a mother’s risk of heavy bleeding, infection and infertility, among other complications, goes up.  Perhaps most alarming, repeat C-sections increase a woman’s chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth.”  This point cannot be emphasized enough.  During their “informed consent” process, are mothers being given this information?  If so, why is there the pervasive cultural belief that C-sections are somehow easier on the mother’s body than natural birth?  Mothers need to know that Cesareans pose significant risks to their reproductive and abdominal health- I personally would not approach this risk lightly, and would only choose a Cesarean if the risks to my baby’s or my own health truly outweighed the risks of the procedure.

Not mentioned in the Time article, but worthy of mention here, are the risks to the baby resulting from a Cesarean.  Babies who are born via c-section are more likely to develop difficulty breathing than babies born vaginally.  There is the risk that, if dates were miscalculated, a baby could be delivered prematurely.  And babies can be injured during the cesarean.  See this link for references and more info on Cesareans.

I am so glad that the VBAC dilemma, and the risks of Cesarean sections, are being covered in the national media.  Once doctors and mothers look at the real risks of Cesareans, we will have motivation to return to the VBAC-friendly practices of the 80’s and early 90’s, to the benefit of mothers and babies everywhere.

For more information on VBAC’s, and Cesareans in general, you can visit:

http://www.ican-online.org

http://childbirthconnection.org/

Any book by Marsden Wagner, Henci Goer, or Nancy Wainer Cohen

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