An Alternative to Multiple Cesarian Sections
What is a VBAC?
A VBAC is a vaginal birth after cesarian section. During the 1980s and into early 1990s, having a VBAC was considered a normal practice. Women were able to choose whether they wanted to pursue this childbirth option.
Then around 1996, the United States saw a decline in VBAC followed by an increase in c-sections. During this time insurance companies determined that the 1% chance of uterine rupture was too much of a liability (Landon, 2005). As a result, VBACs were banned from many hospitals around the country.
OB/GYN physicians began to consider a secondary c-section the only viable option after a primary c-section, which meant they no longer initiated a discussion about options with the pregnant mother.
Regulations were put into place to hinder the option of a VBAC. This procedure would not be allowed unless an anesthesiologist was close to the patient in case of emergencies (Landon, 2005). However, there are not enough anesthesiologists available at most institutions to even remotely supply one for every pregnancy.
Even though the healthcare industry was often quoted saying that women still have choices when it comes to the birth of their children, they removed the possibility of VBAC.
A women's decision on how she will birth her child should be based on facts and transparency on the part of the medical community. These options should be based primarily on the health of the mom and child—and not on irrational fears of litigation.
Sometimes a c-section is necessary, and sometimes a VBAC is not an option, but a woman should know prior to the birth if she is a candidate for VBAC. Her OB/GYN should share information on VBAC openly and honestly.
Has the discussion of VBAC been initiated by your OB/GYN concerning the birth of your child?
NIH Consensus 2010
The conclusions, made by a panel of Physicians and Specialists working for NIH (National Institute of Health) on March of 2010, stated that with the evidence available a trial of labor is a reasonable option for women with prior c-sections (Cunningham, 2010).
The panel felt that the best course of action was to have physicians/midwives offer a six question response sheet to evaluate the safety of the VBAC for each patient and that the hospital should offer to the public their policies of VBAC based on staffing and other variables (Cunningham, 2010).
With a proper screening by the physician/midwife and an open public policy available from each hospital VBAC's should be able to be allowed with little to no risk to the patient or baby (Cunningham, 2010).
The major risk of a VBAC is uterine rupture which is likely in 1% of VBAC's performed. The NIH panel feels that with proper screening and open policies this 1% of patients at risk can be determined. Proper screening and open policies will limited amount of women being turned away from VBAC (Cunningham, 2010).
With this in mind insurance companies should feel free to release their grip on VBAC policy and hospitals can drop their bans on the procedure.
One major concern with keeping the ban on VBAC and continuing with the status quo is the incredibly high amount of primary c-sections being performed in this country. With the current state of VBAC most women will lose their right to have a vaginal birth simply because they had a primary c-section. This c-section could have been for the safety of mom or baby or could have just been an act of convenience.
In reality, there is much more risk in surgery than to attempt a trial of labor after a c-section. Mulitple c-sections can lead to problems with having more children in the future, infections, pain, slow healing times, and hormone management that could affect the well being of mothers after their babies are born (Cunningham, 2010).
Allowing the mother to have a vaginal birth after a primary, or secondary, c-section will allow for greater healing time, natural hormonal balance, and no risk of internal damage to tissues (Cunningham, 2010).
Samuel's Birth Story
When our son Sam was born, my wife suffered from preeclampsia that led to a c-section. We were both unaware of our choices and we did not do much research during the pregnancy.
My wife had quite a few complications after the birth including post partum depression and slow healing. Within the next few years we decided to have another child.
My wife decided that she wanted to have a VBAC to endure a trial of labor for herself and for a better pregnancy outcome. The first thing we noticed was that most OB/GYN in our city would not even consider the option. We did not give up and shopped around until we finally found an OB/GYN that said he was willing to give a VBAC a try.
The pregnancy went well, my wife kept up a great diet and excercised throughout. She was determined to make it work this time and our OB/GYN was agreeing that her body was strong and ready.
When 40 weeks arrived and we were sitting in the hospital waiting for things to progress our OB/GYN told us that hospital policy did not allow VBAC after 40 weeks and that a c-section was needed. Our daughter Hannah was born.
My wife was immediately depressed by the outcome and was convinced that her body was incapable of having a vaginal birth. The fact that she was unable to have a vaginal birth seemed to have negative consequences on her mental well being.
Elias's Birth Story
We decided to try again with our third son Elias. This time she wanted to try for a VBAC after a second c-section. Not only is this unheard of in the OB/GYN community but we were unable to find an OB/GYN physician that would listen to us and we ended up finding a midwife for a VBAC at home.
We were unable to invite the local medical community into our choice due to the harsh judgement that was placed on our decision. Many believed it was selfish of us to put ourselves and our baby in such risk so we went forward in secrecy with our midwife.
The time came for the homebirth and due to placental problems another c-section occurred. I feel that since we fought the good fight my wife dealt a little better with the birth but not by much.
We want to try for another down the road and hope by then to try for another VBAC. Our major concern is that after a certain number of c-sections a woman can no longer have vaginal births or can run into serious risks with just having more c-sections.
An Ongoing Discussion
I am happy to see that a few years after the NIH conference a discussion of VBAC becoming main stream again is occuring.
We see talks on National News Programs and many nurses and OB/GYN are jumping on the bus and questioning the current status quo.
If you are a woman with questions and concerns about VBAC check out your local chapter of ICAN. ICAN is an organization that educates pregnant moms on c-sections and their rights when in the hospital.
A Midwife's Story
- A Thank You To Ina May Gaskin
A look at the world of the midwife Ina May Gaskin, her Farm, her philosophy, and her publications.
- Cunningham FG, Bangdiwala S, Brown SS, Dean TM, Frederiksen M, Rowland Hogue CJ, King T, Spencer Lukacz E, McCullough LB, Nicholson W, Petit N, Probstfield JL, Viguera AC, Wong CA, Zimmet SC (2010). National Institutes of Health Consensus Development Conference Statement: Vaginal Birth After Cesarean: New Insights. March 8-10. Obstetrics & Gynecology, 115(6):1279-1295. https://consensus.nih.gov/2010/images/vbac/vbac_statement.pdf
- Landon, M. B., Leindecker, S., Spong, C. Y., Hauth, J. C., Bloom, S., Varner, M. W., et al. (2005). The MFMU Cesarean Registry: Factors affecting the success and trial of labor following prior cesarean delivery. American Journal of Obstetrics and Gynecology, 193, 1016-1023.
Questions & Answers
© 2014 Jamie Lee Hamann