Comments on: Lightning strikes, shark bites & uterine rupture http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/ Vaginal birth after cesarean? Don't freak, know the facts. Tue, 07 Feb 2012 04:51:05 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Jen Kamel http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-63361 Jen Kamel Sun, 08 Jan 2012 17:32:35 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-63361 Hi Kate! Yes, getting that primary cesarean rate down would greatly impact our total cesarean rate in addition to making women safer in future labors. But I wouldn't argue that VBAC is more dangerous than a repeat cesarean. They both offer risks and benefits and it comes down to which set of risks are acceptable to you. As I said in "<a href="http://vbacfacts.com/2011/11/07/a-father-says-why-invite-the-risk-of-vbac/" rel="nofollow">A father asks why invite the risk of VBAC</a>:" <blockquote>VBACs can absolutely be offered safely without 24/7 anesthesia present. All it takes is a motivated staff that acknowledges that while the risk of infant death or oxygen deprivation in VBACs is 0.05%, the maternal mortality in repeat cesareans is 0.04% (Landon, 2004). Whose lives do we save? And in fact Henci Goer’s analysis shares with us that the 0.05% rate is inaccurately elevated. In the Landon (2004) study, women whose babies had died before labor were encouraged to VBAC. Those infant deaths were included in the 0.05% figure even though their deaths could not be attributed to a labor after cesarean. (For more information, please <a href="http://www.lamaze.org/Research/WhenResearchisFlawed/VBACLandon/tabid/175/Default.aspx" rel="nofollow">Henci’s analysis</a>.)</blockquote> Warmly, Jen Hi Kate!

Yes, getting that primary cesarean rate down would greatly impact our total cesarean rate in addition to making women safer in future labors. But I wouldn’t argue that VBAC is more dangerous than a repeat cesarean. They both offer risks and benefits and it comes down to which set of risks are acceptable to you. As I said in “A father asks why invite the risk of VBAC:”

VBACs can absolutely be offered safely without 24/7 anesthesia present. All it takes is a motivated staff that acknowledges that while the risk of infant death or oxygen deprivation in VBACs is 0.05%, the maternal mortality in repeat cesareans is 0.04% (Landon, 2004). Whose lives do we save? And in fact Henci Goer’s analysis shares with us that the 0.05% rate is inaccurately elevated. In the Landon (2004) study, women whose babies had died before labor were encouraged to VBAC. Those infant deaths were included in the 0.05% figure even though their deaths could not be attributed to a labor after cesarean. (For more information, please Henci’s analysis.)

Warmly,

Jen

]]> By: Cindy B http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-63355 Cindy B Sun, 08 Jan 2012 16:55:24 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-63355 Very good argument about statistics... just to give you a Floridian's perspective... the percentages might even be lower because most of us joke that those hit by lightning are often tourists/non-natives (not that it's really funny) because we know to get inside when there's a storm. So, if you add in all the tourists into the numbers and divide by the actual number of people being struck... I'm sure you come out with a smaller percentage. I love math, btw ;) Very good argument about statistics… just to give you a Floridian’s perspective… the percentages might even be lower because most of us joke that those hit by lightning are often tourists/non-natives (not that it’s really funny) because we know to get inside when there’s a storm. So, if you add in all the tourists into the numbers and divide by the actual number of people being struck… I’m sure you come out with a smaller percentage. I love math, btw ;)

]]> By: Kate http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-63347 Kate Sun, 08 Jan 2012 15:57:00 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-63347 Thanks for that, it would also be helpful to break down the 'rupture' risks; things like the difference between classical scars and lower segment ones, the increased risk if the scar is compromised by a low placenta, the difference made by induction (even 'natural' methods) and the fundamental distinction between a harmless and symptom-free scar separation and a true rupture where mum or baby are in danger. Rupture happens to mums without scars, or with scars from other surgeries too, but they are never frightened with those risks by their care providers, even when the outcomes are often less positive than for a lower transverse section scar that separates! I had a catastrophic rupture - at 33 weeks pregnant, long before any scheduled CS date... Trouble is, the first section, the one that led to the VBAC/Repeat CS debate in the first place, WAS for surgeon convenience and so he could finish his shift and go home... He admitted as much to the OR nurse as he was sewing me up, 'Well that's the last one delivered, time to pack up and we can all go home,' he said. Not me, I couldn't just go home, I couldn't even lift my baby! Yes, I am grateful to the surgical team for saving us when I ruptured, losing more than half my body's blood volume, putting us both in ITU, but nothing like as angry as I am with the one who just didn't want to hang around until I was ready to birth my baby, probably in the middle of the night instead of the more civilised 8pm when he decided to do a section for 'slow progress' - note not no progress, not baby stuck or either of us in trouble, but just too slow for his comfort! I'd rather punch that man in the face rather than buy him a drink. Without that surgeon-led section I would never even have been at risk from a ruptured scar. VBAC is more dangerous, but the biggest problem is that so many primary sections are not necessary, or at least are preventable earlier in labour, and enormous numbers of women are being exposed to a risk of VBAC (even if it is a very low risk) or the risks of repeat major surgery (which are probably higher than the risk of rupture) with out any good cause at all... Thanks for that, it would also be helpful to break down the ‘rupture’ risks; things like the difference between classical scars and lower segment ones, the increased risk if the scar is compromised by a low placenta, the difference made by induction (even ‘natural’ methods) and the fundamental distinction between a harmless and symptom-free scar separation and a true rupture where mum or baby are in danger. Rupture happens to mums without scars, or with scars from other surgeries too, but they are never frightened with those risks by their care providers, even when the outcomes are often less positive than for a lower transverse section scar that separates!
I had a catastrophic rupture – at 33 weeks pregnant, long before any scheduled CS date… Trouble is, the first section, the one that led to the VBAC/Repeat CS debate in the first place, WAS for surgeon convenience and so he could finish his shift and go home… He admitted as much to the OR nurse as he was sewing me up, ‘Well that’s the last one delivered, time to pack up and we can all go home,’ he said. Not me, I couldn’t just go home, I couldn’t even lift my baby!
Yes, I am grateful to the surgical team for saving us when I ruptured, losing more than half my body’s blood volume, putting us both in ITU, but nothing like as angry as I am with the one who just didn’t want to hang around until I was ready to birth my baby, probably in the middle of the night instead of the more civilised 8pm when he decided to do a section for ‘slow progress’ – note not no progress, not baby stuck or either of us in trouble, but just too slow for his comfort!
I’d rather punch that man in the face rather than buy him a drink. Without that surgeon-led section I would never even have been at risk from a ruptured scar. VBAC is more dangerous, but the biggest problem is that so many primary sections are not necessary, or at least are preventable earlier in labour, and enormous numbers of women are being exposed to a risk of VBAC (even if it is a very low risk) or the risks of repeat major surgery (which are probably higher than the risk of rupture) with out any good cause at all…

]]> By: Stephanie http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-63343 Stephanie Sun, 08 Jan 2012 15:20:59 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-63343 I love this....excellent! *applauds* well done! My second biggest complaints (after the misrepresentation of statistics) is this: choosing a repeat elective cesarean doesn't just eliminate the existing risk of a uterine rupture, it trades it for the risks of a cesarean (which are rarely discussed when talking about VBACs) It also drives me crazy when people act like "low risk" means "no risk". "I am 22 and my baby had Down Syndrome!" Being at a lower risk doesn't make you at no risk. Even if the risk WERE the same as being struck by lightening...doesn't mean you won't be struck by lightening! The reason we have those statistics is because it does, indeed, happen to some people. (no matter how much you put your head into the sand) Good job...good post...thank you for this!! I love this….excellent! *applauds* well done!

My second biggest complaints (after the misrepresentation of statistics) is this: choosing a repeat elective cesarean doesn’t just eliminate the existing risk of a uterine rupture, it trades it for the risks of a cesarean (which are rarely discussed when talking about VBACs) It also drives me crazy when people act like “low risk” means “no risk”.
“I am 22 and my baby had Down Syndrome!” Being at a lower risk doesn’t make you at no risk. Even if the risk WERE the same as being struck by lightening…doesn’t mean you won’t be struck by lightening! The reason we have those statistics is because it does, indeed, happen to some people. (no matter how much you put your head into the sand)

Good job…good post…thank you for this!!

]]> By: KoryO http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-38765 KoryO Thu, 11 Aug 2011 13:07:18 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-38765 Melanie....really? Is that the BEST you got??? You obviously can't argue with logic, since you don't address any of the points made here, and your attempt to baffle with BS is a D-. And I'm a generous grader. See, I was one of those so-called nonexistent UR cases that Jen is talking about here. I had only one prior c-section, and was not induced to start labor. If there was a poster girl for VBAC, that would have been me. It all went beautifully until the last couple of minutes. Then all hell broke loose. (I'm guessing that you have never been on the patient end of a UR. I hope you never are. It was the most frightening thing I have ever experienced, bar none. I was on the table for two hours getting sewn up, and I lost 2 liters of blood.) If my doctors were really THAT into getting home for dinner, I don't know why they would have "let me go" from 3 am to 5 pm in my TOLAC. On a Friday. I mean, not only did they miss dinner, they also missed happy hour....and in a university town, you don't wanna miss happy hour on Friday. Which reminds me....the next time I'm there, I'll buy those doctors a round. It's the least I owe them for saving me and my baby girl. Melanie….really? Is that the BEST you got??? You obviously can’t argue with logic, since you don’t address any of the points made here, and your attempt to baffle with BS is a D-. And I’m a generous grader.

See, I was one of those so-called nonexistent UR cases that Jen is talking about here. I had only one prior c-section, and was not induced to start labor. If there was a poster girl for VBAC, that would have been me. It all went beautifully until the last couple of minutes. Then all hell broke loose. (I’m guessing that you have never been on the patient end of a UR. I hope you never are. It was the most frightening thing I have ever experienced, bar none. I was on the table for two hours getting sewn up, and I lost 2 liters of blood.)

If my doctors were really THAT into getting home for dinner, I don’t know why they would have “let me go” from 3 am to 5 pm in my TOLAC. On a Friday. I mean, not only did they miss dinner, they also missed happy hour….and in a university town, you don’t wanna miss happy hour on Friday.

Which reminds me….the next time I’m there, I’ll buy those doctors a round. It’s the least I owe them for saving me and my baby girl.

]]> By: Melanie http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-16576 Melanie Sat, 01 Jan 2011 05:23:12 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-16576 Remember C-section is VERY dr freindly... No waiting, no watch and see, no teing up a bed for hours while nature takes its course...and yes they can be home for dinner. I may sound a bit sarcastic, but it is true... Remember C-section is VERY dr freindly…
No waiting, no watch and see, no teing up a bed for hours while nature takes its course…and yes they can be home for dinner.

I may sound a bit sarcastic, but it is true…

]]> By: Jen Kamel http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-7740 Jen Kamel Mon, 28 Jun 2010 02:17:33 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-7740 Mumofar, Thank you so much for all your kind words! Warmly, Jen Mumofar,

Thank you so much for all your kind words!

Warmly,

Jen

]]> By: mumofar http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-7718 mumofar Sun, 27 Jun 2010 04:50:55 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-7718 i just found this website but have been reading through different posts. i must say, i love you! it is hard to find someone so balanced! i spent the whole day the other day being bullied by a bunch of extremists homebirthers who refused to believe any pro-hospital statistics and then had their own completly unsubtatntiated claims that they kept trying to force down my throat. so, I am completely thrilled to find someone who is supportive of VBACs, realistic about the risks and able to comprehend that not all stats are equal and a critical mind must be used when approaching them. there's so much work to do to look through the vast piles of information in this area and it's so nice to have someone, and a website like this, to help! you are my hero!! xxxxxxx i just found this website but have been reading through different posts. i must say, i love you!
it is hard to find someone so balanced! i spent the whole day the other day being bullied by a bunch of extremists homebirthers who refused to believe any pro-hospital statistics and then had their own completly unsubtatntiated claims that they kept trying to force down my throat.
so, I am completely thrilled to find someone who is supportive of VBACs, realistic about the risks and able to comprehend that not all stats are equal and a critical mind must be used when approaching them. there’s so much work to do to look through the vast piles of information in this area and it’s so nice to have someone, and a website like this, to help!
you are my hero!! xxxxxxx

]]> By: Onbirthing http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-6221 Onbirthing Mon, 23 Nov 2009 23:53:58 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-6221 [...] Yet since the ACOG guidelines came out in 2004, more and more hospitals have refused to do VBACs. Today, nearly half of hospitals won’t do VBACs, either because the hospital has banned them or because doctors won’t do them.  WHY?? All this for a less than 1% chance that something could go wrong. And what does a less than 1% chance mean exactly? [...] [...] Yet since the ACOG guidelines came out in 2004, more and more hospitals have refused to do VBACs. Today, nearly half of hospitals won’t do VBACs, either because the hospital has banned them or because doctors won’t do them.  WHY?? All this for a less than 1% chance that something could go wrong. And what does a less than 1% chance mean exactly? [...]

]]> By: Kristen http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-3831 Kristen Thu, 27 Aug 2009 13:02:42 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-3831 Yes, great post! I've seen these things stated so many times and have never taken the time to look up the stats on this information--thank you for doing so! You're right: misinformation is terrible no matter which way one looks at it. Yes, great post! I’ve seen these things stated so many times and have never taken the time to look up the stats on this information–thank you for doing so! You’re right: misinformation is terrible no matter which way one looks at it.

]]> By: Sarah http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-3443 Sarah Sun, 23 Aug 2009 18:54:59 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-3443 Great post, Jen! A great point of caution. I've seen this email many times. I've highlighted your post on the ICAN blog's weekly feature "Best of the Birth Blogs" for this week (ending 8/23): http://ican-online.org/community/users/ican-blog/blog/best-birth-blogs-week-ending-august-23rd All best, Sarah Great post, Jen! A great point of caution. I’ve seen this email many times. I’ve highlighted your post on the ICAN blog’s weekly feature “Best of the Birth Blogs” for this week (ending 8/23): http://ican-online.org/community/users/ican-blog/blog/best-birth-blogs-week-ending-august-23rd

All best,
Sarah

]]> By: Childbirth Education | Doula Support | Allentown | Lehigh Valley | Baby Birthing | Knitted in the Womb » Where can I find information to help decide whether or not to pursue VBAC? http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture/comment-page-1/#comment-3048 Childbirth Education | Doula Support | Allentown | Lehigh Valley | Baby Birthing | Knitted in the Womb » Where can I find information to help decide whether or not to pursue VBAC? Fri, 21 Aug 2009 22:17:39 +0000 http://vbacfacts.com/2009/08/18/lightening-strikes-shark-bites-uterine-rupture/#comment-3048 [...] Lightning strikes, shark bites & uterine rupture [...] [...] Lightning strikes, shark bites & uterine rupture [...]

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