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Response to OB: Scare tactics vs. informed consent aka why I started this website

I receive this comment on the post Hospital VBAC turned CS due to constant scare tactics:

I am very disheartened by the tone of this website. I am a board certified Ob/gyn and a very strong advocate for VBACs, IF a patient chooses one within the hospital guidelines. I DO believe and say to my patients my goal is “a healthy mom and a healthy baby” because I truly believe this statement. You would not believe the number of patients who believe that I want to do XYZ to go home to my family, go shopping or improve my golf game. A vaginal delivery is easier for me in the long run because I have less paper work, less rounding and have avoided performing a major surgery on a patient. I have no desire to perform a patient’s 6th c-section!

But each patient who chooses a VBAC has to realize there ARE risks associated with the procedure. I would be committing malpractice if I did not inform each patient of the risks and benefits of both options. The risk of uterine rupture is [less] than 1 percent, but if it happens to my patient she will be upset that I did not inform her of the risks. The “seeds of doubt” you discuss are all things that I have told patients considering a VBAC. I prefer to stretch the informed consent process over the entire course of the prenatal visits versus just one 5 or 10 minute conversation. If I have discussed all the options ahead of a patient’s actual labor, if I come in and say that I need to perform a repeat c-section for XYZ reason, I am not having that discussion for the first time in the LDR, but rather we have discussed the possibility months ago. I use my prenatal visits to build a repoir [sic] with my patients and to educate her/her family about the scenarios we may face in the delivery room.

In an ideal world, every patient would be presented with the option to have a VBAC if she desires. Unfortunately due to the malpractice climate some doctors and hospitals no longer feel comfortable giving patients this choice. The rhetoric in this article does nothing healthy to advance the cause  of ensuring this happens. It only serves to create mistrust between patients and doctors who are true advocates for patients.

Dear VBAC Supportive OB/GYN,

I’m very happy that you left this comment and hope that you stick around and read some more.  We need more OBs who are supportive of VBAC and vaginal birth.  (I’m curious about your hospital’s guidelines.  Would you share?)

The unfortunate reality is that there is a huge segment of OBs who perform surgery under the guise of maternal/fetal health when in reality it is for their personal convenience.  I have had the opportunity to hear that directly from OBs.  Often the “healthy mom/healthy baby” reason is used in the midst of a repeat cesarean recommendation and I believe that is true in the birth story featured in Hospital VBAC turned CS due to constant scare tactics.

If you look over on the category list and click on ‘uterine rupture’ you will see that it is a common topic on this site.  I cite specific rates as well as sources so people can independently verify what I write.  I absolutely agree that women need to understand the risks of VBAC, but they need the accurate numbers, not some inflated risk provided by an unsupportive OB and not some understated risk provided by well-meaning, but misinformed, birth advocates.  (Check out my article Lightning strikes, shark bites & uterine rupture for more on this.)

Here’s how I make the distinction between informed consent and scare tactics.

Informed consent is understanding the risks and benefits of VBAC vs. repeat cesarean.

Scare tactics are just talking about the risks of VBAC without mentioning the risks of a repeat cesarean.

Informed consent includes accurate statistics.  Women write me all the time telling me that their OB quoted a uterine rupture rate of 5% or 10% or even 25%!  A woman just recently contacted me and said that women seeking VBACs are “selfish, unbelievable IDIOTs.”  Naturally she would say this as her OB told her that she and her baby had a 10% chance of dying if she attempted a trial of labor after cesarean.

If the doctor tells you there is a 10% chance of you and your baby dieing [sic] and you do this any way…you are a selfish, unbelievable IDIOT…I have two perfect babies and I wouldn’t have my 1st if it wasn’t for a c-section…why on earth would I risk the life of my 2nd child to say I had a ‘v-back’…do you psychos want a metal [sic]…go away and get off your freakin’ soap boxes…you are all scary and creapy [sic]!

This is why I started the website.  Women are lied to all the time.  They contact me either via angry emails like the one above or really sad depressed emails because they were fed these falsehoods, consented to surgery, and then learned the truth.

So, this is how I responded:

I completely understand why you were happy to have a repeat cesarean given that you were told the risk of mortality was 10%. I’m sorry to tell you that you have been misled. The risk of maternal mortality with repeat cesarean and VBAC is very low, but the risk is higher with a repeat cesarean: 0.04% vs. 0.02% per a National Institute of Health Study of 18,000 women. (Landon 2004: http://content.nejm.org/cgi/content/abstract/351/25/2581) This is 500 times smaller than the risk you were quoted of 10% maternal mortality. That same study found the rate of infant death to be 0.01% and they did a review of 880 uterine ruptures in a 20 year period resulting in 40 infant deaths in 91,039 VBACs which is a rate of 0.04%. They found the combined risk of infant death or brain damage to be 0.05% or 1 in every 2000 VBAC labors which is a 200 times smaller than the risk you quoted of 10%. If you or your OB have a large VBAC study showing a 10% mortality rate, please email me.

Needless to say, she did not respond as there is not one large VBAC study showing maternal or infant mortality rates anywhere near 10%.  This woman was lied to.  Why do you suppose her OB would tell her that?

Informed consent also includes asking how many more children the woman wishes to have.  We know that the risk of uterine rupture, uterine dehiscence and other peripartum complications decrease after the first VBAC, (Mercer 2008) whereas the risk of “placenta accreta, hysterectomy, transfusion of 4 units or more of packed red blood cells, [bladder injury], bowel injury, urethral injury, ileus [absence of muscular contractions of the intestine which normally move the food through the system], ICU admission, and longer operative time were seen with an increasing number of cesarean deliveries.  [In addition] after the first cesarean, increased risk of placenta previa, need for postoperative (maternal) ventilator support, and more hospital days were seen with increasing number of cesarean deliveries.” (Silver 2006)

How many VBAC consent forms include the risks of cesarean?  Not just the risks to mom and baby in the current pregnancy but the downstream consequences for future pregnancies?  I’ve never seen it.  Does your VBAC consent form include this information?

It’s one thing to understand the risks of VBAC, but they must be countered with the risks of repeat cesarean, otherwise the patient is left with the false notion that repeat cesareans are risk free.  This does not benefit the patient and I believe it’s only because women haven’t started suing over complications resulting from repeat cesareans that this erroneous philosophy on informed consent continues to thrive.

Informed consent is putting the risk of uterine rupture into perspective by comparing the risk to other obstetric complications as Larry Leeman MD MPH and Eve Espey MD MPH do when expressing their concern over the rising cesarean rates in Native American populations due to hospital VBAC bans.  They say:

Should you offer vaginal birth after cesarean delivery at your facility?

Should your referral facility be offering VBAC?

Let’s put some of the above issues into perspective.

What are just a few of the risks that you should currently handle very well:

[Note from me: I used the chart they provided here and combined it with uterine rupture & infant mortality/morbidity stats for use in the VBAC Class I teach.]

Slide 103

Taken on their own individual merit, most of the above common urgencies and emergencies occur more frequently than 0.5 percent. Taken as an aggregate, the risks above far outweigh the risks of VBAC. Now seeing the above risks, if you feel you need to re-evaluate offering obstetric intrapartum care because the above risks, then please contact me as soon as possible.

Scare tactics are simply saying, “VBAC is dangerous” or “Is it worth your baby’s life?”

Informed consent is having a thoughtful thorough conversation where you ascertain if this is the first time the woman has heard about the risks of uterine rupture, or if she is an informed patient who is well aware of her risks, benefits, and options.

I do believe that coming back to the risks of VBAC again and again during a pregnancy conveys to the patient that you really think this is a considerable risk, and not one worth undertaking.

Lisa Allee, CNM, wrote this in response to a hospital that instituted a VBAC ban.  The hospital said that their ban wouldn’t impact many since only 2 patients a year perused VBAC after the VBAC counsel.  She recommended:

Re-evaluate how VBAC counseling is done. To provide true informed consent the numbers need to be presented clearly. The data consistently shows a uterine rupture rate of 0.5-3%–it is important to explain that this means 97-99.5 women out of 100 will not have a uterine rupture and out of the few that do, not all will have problems. It is, of course, important to discuss the risk of uterine rupture to mother and baby, but to put it in this perspective of being rare and review the high-quality, careful care we provide to women who are VBACing to help prevent problems. It is also very important to review the differences in postpartum morbidity and risk between a vaginal birth and cesarean delivery, (be sure to include the oft ignored higher rates of breastfeeding and orgasm difficulties post cesarean delivery.) If, in contrast, providers only make a recommendation of repeat cesarean delivery and an institution has a policy that only allows for repeat cesarean delivery, then they have effectively negated a woman’s right to make an informed decision in a situation where there is a choice.

And she suggests that women be given an accurate picture of what a cesarean is like:

Review the postpartum morbidity and risk differences for women post vaginal birth vs. post cesarean delivery. This will help to dispel the delusion that a woman who has had a cesarean delivery is walking out of the hospital “healthy” and bring a more accurate sense of respect for what is really happening for that woman. She has just had major abdominal surgery and is in recovery from that surgery. She is in pain and is at risk for a number of post-surgical complications. Her future pregnancies have also now taken on a longer list of potential risks. Along with all this she is also a new mother with a newborn to care for and feed every 1-2 hours with an abdominal incision that she is fully aware of each time she moves. This human perspective of the implications of a cesarean delivery might help providers to be concerned with their personal and institutional cesarean delivery rates.

I did not get the feel from the birth story relayed in Hospital VBAC turned CS due to constant scare tactics that the OB was really supportive of VBAC, did you?  Would you classify this OB as a “true advocate for patients?”

  • OB only talks about the risks of VBAC.
  • OB required a VBAC consent form that only lists the risks of VBAC.
  • OB wants to schedule a cesarean at 38 weeks.
  • OB “did not seem very please” when the patient expressed her desire to VBAC.
  • OB began NST at 37 weeks.  Patient lists no reason for this.
  • OB does not put the process and significance of dilation into context.  Patient seems to believe that no dilation at 37 weeks and no change till 40 weeks is a bad sign.  Patient does not understand that dilation is not a hard sign of labor.
  • OB tries to scare patient by telling her that her baby was big and it “could be a very hard delivery” for her.  It is this scare tactic, and the subsequent recommendation for cesarean based on suspected macrosomia  that convinces patient to schedule a cesarean.  Baby ends up weighing 7lbs 2oz.  ACOG does not recommend cesarean for suspected imagemacrosomia unless the baby is 11lbs (ACOG’s Practice Bulletin No. 22 on Guidelines for Fetal Macrosomia published in the November 2000 issue of Obstetrics and Gynecology).
  • OB makes a “threatening call” to patient upon her spontaneous labor and lies by saying that if patient doesn’t have the “C-sec at the decided time, [OB] was not going to be available for the entire week and that some random doctor from the hospital” would perform her surgery.
  • OB gets caught in this lie when the nurse tells patient that OB “has asked to be informed about your progress [and] will continue to be there for you.”
  • OB then has a colleague tell patient that “she was sure it was going to be a very tough delivery” because of “baby’s head was big” and would weight “at least 8 lbs.”
  • OB who said she wouldn’t be available after 11:45am, suddenly becomes available and is present to perform the surgery.

You stated in your comment that my article “only serves to create mistrust between patients and doctors who are true advocates for patients.”

Here is my sole goal with that article and this website: To implore women to put as much effort into interviewing and hiring an OB as they would for someone to install a pool.  Educate yourself.  Get referrals.  Ask questions.  Don’t just stay with your current GYN because they do a great pap smear and you enjoy the small talk.  Hire someone who has a birth philosophy similar to yours.  Hire someone who is supportive of vaginal birth!  And look for the red flags!  There were so many in this woman’s story.  I know we disagree on that.  Maybe that is because you are a VBAC supportive OB who doesn’t see stories just like this one every day.

While there are OBs who are truly supportive of VBAC, I personally know three, most are not.  Most behave exactly like this OB.  And I don’t believe for a second that this OB ever intended to give this patient a genuine opportunity to VBAC. I really wish the OB would have just said that upfront to the patient so she could have had the opportunity to hire a truly supportive practitioner.  At the very least, this OB can post a sign in their waiting room, like this one above from a Provo, Utah practice, so women know their birth philosophy as soon as they walk in the door.  As unappealing as it is, this practice is providing their patients with informed consent on the type of birth they provide.  What is shocking to me, is that there are enough patients who are so ill-informed that they would continue care with a practice like this.

And this site will be there for the women who had cesareans under the care of OBs, like this Provo practice, to provide them with accurate, easily verifiable information for them to make an informed decision on what kind of birth they want the next time.

Warmly,

Jen

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33 comments to Response to OB: Scare tactics vs. informed consent aka why I started this website

  • Amy

    Outstanding reply.

  • Lori

    I appreciated that the doctor took the time to reply in the manner in which it was done. My concern is the comment, “But each patient who chooses a VBAC has to realize there ARE risks associated with the procedure.” My hope is that the good doctor also recognizes that an equally important statement would be, “Each patient undergoing cesarean surgery has to realize there ARE risks associated with the surgery.” I found that missing from his response but hope it’s part of those prenatal discussions.

  • Karma Tucker

    I read this and felt the need to comment. I have three children. The first two were c-section and the last was vaginal. My first child was footling breech. The second was “not responding well” to labor. Later I found out that my Dr. uses more pitocin than any other Doctors (he has a reputation among the nurses) just figuring that an epidural will take care of the pain. I will never know, but perhaps the baby needs to let nature work instead of forcing it faster.

    That lead me to not return to that doctor. I appreciate the message the ob left on this board and would like to respond to that person. For my third child I wanted a VBAC. First I had to search for one who might be willing. I explained this to him at our first meeting. For every visit thereafter he proceded to “let me know” of all the risks. STOP!!! I want that 5-10 minute discussion instead of bombarding me with “warnings” each visit. The feeling I got was that he was trying to talk me out of a VBAC. Finally I had to see a partner in his office and his comments were “I see no physical reason you can’t have this baby naturally” and then he went about discussing how that would happen. I switched doctors. The one who was supportive after making sure I knew the risks is the one I have recommended to friends. That doctor is the one who through my recommendations has gotten more patients.

    If you want to build repoire with your patients, let them know the risks and when that is established BE SUPPORTIVE. The last thing a patient needs is to be irritated with the doctor she has chosen to help. It is because the doctors are not listening that doulahs and home births are more and more popular. I think that all ob’s ought to look at that and realize there is a reason for it. After the risks are conveyed and the patient is aware of them, note it in the chart and have the nurse sign it if there are future legal worries. Then get ready for the baby. Mothers are less likely to sue someone who they feel truly tried their best to have a birth go their way.

  • Kelly

    Thank you letting women out there that OB’s WILL lie to them. This happens entirely too much, a good friend of mine had a c-section with her first son and was told that if she were to even try to have a VBAC with a second child that the baby would be stillborn for even trying.

    I am so glad that you are here to spread truth among all of the lies.

  • Jen, you are my freaking HERO. I had almost this exact conversation with a very VBAC supportive OB at the Breech Birth Conference… except I wasn’t as organized and conversant as you. =)I
    am going to bookmark this post and just send OBs straight here…

  • I have a personal qualifier for whether a doctor is PRO-VBAC (meaning pro-letting-a-woman-use-her-very-own-vagina) or whether he/she simply THINKS they are Pro-VBAC. This qualifer is listed below.

    What a Pro-VBAC Provider does NOT do:

    Pro-VBAC providers do not schedule cesareans without a valid medical reason that is supported by science and evidence

    example: a previous cesarean, suspected big baby (macrosomia), and post-dates are not necessarily considered valid medical indications for an elective cesarean surgery

    Pro-VBAC providers do NOT induce labor without a valid medical reason supported by science and evidence

    Pro-VBAC providers do NOT force (or suggest without real cause) unwanted interventions and procedures on a pregnant or laboring mother (these include electronic fetal monitoring, pain medication, epidurals,pitocin, catheters, IV’s, and other interventions.)

    Pro-VBAC providers do NOT use scare tactics or threats to influence a mother to make decisions about her care.

    Pro-VBAC providers do NOT practice “defensive medicine.”

    Pro-VBAC providers do NOT question a mother’s emotional or physical need to have a vaginal birth, and do not make comments to the effect of “all that matters is a healthy baby” or tell a mother that cesarean is “just the same as VBAC.”

    Pro-VBAC providers do NOT rush the birth process, and do not put time limits on labor absent any valid medical reason.

    What a Pro-VBAC Provider DOES do:

    Pro-VBAC providers DO present all the risks AND benefits of both a VBAC and repeat elective cesarean without bias or influence toward a repeat cesarean delivery absent a valid medical reason

    Pro-VBAC providers DO allow a mother to eat, drink, and move freely during her labor absent a specific medical indication otherwise

    Pro-VBAC providers DO support the emotional and physical well-being of a mother both during the pregnancy, during the delivery, and in the post-partum period.

    Pro-VBAC providers DO encourage mothers to have labor support, and to be educated about the birth process

    Pro-VBAC providers DO encourage a mother to utilize natural and non-invasive pain management techniques (such as Hypnobabies, Bradley, or Lamaze) before the use of chemical methods which carry their own risks.

    Pro-VBAC providers DO allow pregnancy and labor to progress naturally without overactive management, absent any true medical indication otherwise

  • Amy

    My OB quoted a different UR rate (5%, 10%, and 20%) every time we discussed my desire to VBAC. Thanks to information from sites like yours, I wasn’t scared off. In the end, I had a successful hospital VBA2C with this OB with minimal intervention. In some ways I felt like he was testing me to see how committed I was, but I’m so glad we were able to make it work despite the initial discouragement.

  • Heather

    I love this. This was very well written and very well researched. I think I’ll have to bookmark this. I had a c-section with my dd and if I have a second I have every intention of trying for a vbac. I had a horrible c-section experience. Don’t get me wrong I loved my OB and have no qualms with him. I think he did a great job. However my anesthetic stopped working during my c-section and that was very painful and rather traumatic. I hope to never have to go through it again. I would in a heartbeat if I had to for another healthy baby, but I’d rather not. I don’t recall ever being told the statistic for epidurals failing during c-sections but it’s amazing how many other women had the same thing happen to them the same year my daughter was born.

  • Gretchen

    Beautifully said. I hope women and physicians will make an honest attempt to set aside their own biases and read it with an open mind.

  • Jen, this is very well written and documented. I’ve come across several OB doctors claiming to be VBAC-friendly and yet they still attempt to lump ALL OBs into the same group, as if they’re all on the same page. The fact that an obstetrician would see your article as *ONLY* serving “to create mistrust between patients and doctors” is a HUGE red flag for me and makes me question, even more, any OB who initially claims to be VBAC-friendly. It’s a catchy phrase, but means nothing if not backed by whole-heart listening and compassion for those who have experienced quite the opposite. To ask women to educate themselves and ask questions is no crime. It’s necessary. And we have continued to witness that beliefs instilled in a patient during a pregnancy dramatically affects a healthy outcome. Should all of those beliefs be only in the hands of one doctor? Shouldn’t we take a little initiative to fact-check and question evidence? Boy do I wish I had done that before my first two pregnancies.

    I’m thrilled to see more sites like vbacfacts.com slowly making an appearance. It’s very indicative of what women are experiencing and missing in their providers (and birth), today.

  • Sarah M.

    I’m pregnant with my 8th child. I delivered my first two by c-section, the first for dubious reasons (overdue, water broken by provider — too early, too big baby–my smallest, etc., etc.),
    the second scheduled because I couldn’t find VBAC info.
    By the third I decided to change providers to a VBAC allowing practice. VBAC was great!
    Transferred back to my local provider/hospital when they got midwives, and delivered the last 4 there by VBAC, two of whom were over 10 1/2 lbs!
    So I’m now 5VBA2C, and our local hospital’s new policy is NO VBACs, no exceptions.
    I transferred back to the hospital that delivered my first VBAC, only to find they are no longer comfortable with a VBAC after 2 c-sections.
    It has been a very frustrating few months, and I finally got one of the OBs to sign off on my VBAC.
    He had to admit there are NO statistics for a woman who has had 2 c-sections and 5 VBACs. He also pointed out that a risk of uterine rupture also exists because of the number of kids I’ve had, whether I’ve had a c-section or not.

    I feel like begging first younger moms “PLEASE protect your uterus, especially if you want more kids!”
    True emergency c-sections are a God-send. I’ll take it if I need it. But if not, I see no reason that after 13 years and 5 VBACs, I need to subject myself to surgery.

    And, no, my VBAC form had NO risks of c-section, nor do I remember any emphasis on the risks when I actually HAD my c-sections!!!

  • Stephanie

    I am going for a vba3c, and I don’t think that my current ob will let me try because with baby number 3 she never even discussed vbac she just went straight for a scheduled section. I will try one more time because I do like and trust her, but I am going in armed with information, and with the clear intention that if I don’t get the right answer and support, I will seek another care provider.
    Don’t get me wrong I am absolutely terrified of labor and birth, and I am also terrified of another c-section. They are both really scary. But I think my biggest fear is how I will feel if I am never given the chance to do what my body was made to do. I had a mismanaged labor, with my son and it has just snow balled from there.

    Stephanie

  • Jen

    Jen, you are my (VBAC) hero. As always you are well written and well researched. Thanks for being such an outstanding source of information.

  • Sarah, I asked my hospital CNM if there were any increased risk for UR from having more children after having a cesarean. I had a CS with my first and since then have had two wonderful VBACs. She said there is no increased risk due to more children and that as the years go by by since my surgery, risk of UR only decreases. I find that interesting that they told you that more kids equals more risk. I wonder if there are any studies on that to confirm or not.

    Thank you Jen, for another superb post and for all your hard work.

  • I should specify that by having more children I mean vaginally. Of course each cut equates increased risk.

  • Lauren S., when I was looking for a doctor for my 4th VBAC, one doctor told me over the phone that the risk of uterine rupture *increases* with each VBAC — so my 4th VBAC would be MUCH more dangerous than my 1st. Thankfully I knew better.

    I did end up having another c-section, but due to actual fetal distress, not scare tactics. (The doctor who attended my birth — though I had never met him before that — was wonderfully supportive. He kept looking for different ways to help my baby, saying, “We really want to avoid another c-section.”)

  • [...] especially love her post looking at OB scare tactics.  If you are a mom thinking about a VBAC you have to read this post.  It really demonstrates the [...]

  • Keep up the great job providing this important info to moms. Women are misinformed and they take what their provider says as gospel. Kudos to the physician who commented, but his colleagues are out their scarying women to death. I will tell my patients to check out this website. Unfortunately in the practice I am currently, the patient has to do the VBAC consult with the MD, and we lose alot to repeat C/S that way. Very sad…

  • [...] Facts – Response to OB: Scare tactics vs. informed consent aka why I started this website: Jen responds to an OB’s comment on her website with some important thoughts on supporting [...]

  • Jenny Griebenow

    Jen, as usual, thanks for an awesome well written resource!!

  • Amy

    I have had 5 unessesary c-sections and I want a vbac but I can not
    find a doctor or midwife to perform a vbac after 5 c-sections.
    Does anyone know of anyone that would let me have a vbac in Texas?
    I live close to the Houston area but would travel within reason my
    e-mail is chomper911@yahoo.com

  • Carina S.

    My 1st was breech, following the medical model (all I knew) I tried a ECV (Version) and it failed, I was sectioned.

    My 2nd was breech, went w/ midwives, labored 24 hours, water broke 12 hours in, at 22 I started w/a fever, and went from dialiated to 8 and 0 station, I was at 6 and -1 by the time I (safely) arrived at the hospital for section #2.

    I’m 39w 5d with #3, and although I’ve had the same plan/agreement with my OB’s since week 10, to go into labor natuarally, and if baby is head down vbac, and if he’s breech I’ll consent to the c/s. Now I’m getting scare tactics from Dr. L and out right LIES from Dr. W to scare me into scheduling since I’m still breech as of today. Dr. Z is totally on board with my wishes, he knows I research including acog and med journals. The others try to make me feel like I’m jeoporadizing my baby’s health. OHMYGOSH!!!

    Mom and baby are BOTH healthy, he’s just not in the ideal position. WHY on earth would I schedule a major surgery? I’m in awe at the lack of knowledge and the rude attitude. I employ them to help me, not to tell me what to do as if I’m a knocked up teenager clueless to the process.

  • Brenda

    I am so glad I found this website, I had a c-section with my first baby due to not dialating and with my second I was already in labor when a doctor came in and used “scare tactics” and scared me into having a repeat c-section. I am now pregnant with my third and really want to have a vaginal birth but my OB is not even giving me the option I asked her about it and she said “no, there are too many risks involve and also I would like to schedule a tubal ligation.” I was like, huh? What makes her think I don’t want more kids? I feel like I’m being told what to do instead of being asked what I want. Now, that I am more informed I will stand up for myself and for what I want in my birthing experience. Thank you so much for all your help.

  • [...] hospital VBAC bans (Kamel, 2010); unsupportive health care providers, friends, and family (Kamel, 2009b & 2010b); or the misrepresentation of VBAC risks (Kamel, 2009b & [...]

  • Jamie

    While I was struggling to still have a natural labor with my second the nurse kept feeding me information. One of her interesting pieces of insight was “you don’t know how many times I’ve had a woman VBAC and then saw her baby right through her uterus(meaning rupture)”. I wish I knew then what I do today then I would have known she was full of it and just trying to get me to have a cs.

  • Laura

    I have had 2 c-sections and 8 vbacs. My sections were with babies #1 and #9. With my 10th pregnancy at 36 wks the local hospital changed their policy and no longer allowed a vba2c. I found an OB 2 hrs away who was willing to allow me a TOL and had another successful vbac. (He is not an option this pregnancy.) Now, 2 yrs later I am expecting again. I had an u/s at 12 wks to check if baby was alive as I’ve had 3 losses since our last baby. The u/s tech took an image of my scar, and left a comment on my records for the NP who ordered the u/s saying that the scar is thin and recommending I see an OB or Peri. I was planning a homebirth. I have a consultation appt. set up in 2 wks, but have been subject to scare tactics so many times over the last few years that I don’t trust anyone. Do you have any info regarding if the LUS is thin at 12 wks does that mean a vbac would be extremely risky? I’ve been reading as much as I can on your site, until my brain has glazed over! I would greatly value any thoughts you might have on my situation. Thank you!

    • Jen Kamel

      Laura,

      I think the research studies on uterine thickness and rupture are not large enough to base clinical decisions on.

      You can read a review of the research here.

      Warmly,

      Jen

  • Julie D

    I love when ladies share strength! As the wife of a Family Medicine MD (who loves to deliver babies and strives to let it be as natural a process a possible, bless him), and the mom of 3 kids (#1 breech c-section; #2 VBAC 8 lbs but on unnecessary epidural for mis-management of labor–even MD’s wives are not immune, #3 VBAC 6 lbs and almost no intervention–fantastic!), I have strong feelings about this topic! When considering why OB’s push for c-sections, consider: C’s can be scheduled so they’re convenient, while natural birth might mean the OB being called in inconveniently; C’s pay better than vaginal; C’s provide training for resident doctors, who have quotas in order to be certified in procedures. I cannot count how many times my frustrated husband has come home because the senior OB (who inevitably sees Fam Med as inferior and incapable) has been pushing interventions and rushing patients to unnecessary C’s because he just wants to “clear the board” of laboring patients, free up beds, and go to sleep himself. If you have a medical provider (OB, Fam Med, whatever) who sees patients as cases instead of valuing the life-event you’re experiencing, RUN! He/She will have no hesitation subjecting you to unnecessary and unpleasant interventions that will increase your risk factors in many areas and may leave you with birth PTSD, or at least emotional baggage that you will carry for a long time. Delivery is not a disease, and a healthy woman should be expected to deliver a healthy baby with virtually no intervention whatsoever. Use your medical professionals to reassure you that the process is happening as it should, and let your body do the rest!

  • Mary Ann Watson Hall

    I am a semi-retired Certified Professional Midwife and grandmother. My youngest daughter had a cesarean section due to proven fetal distress and we were glad to get it. However, the first thing the OB told us after his opinion for the need for cesarean was that this did NOT mean that she would have to have another cesarean for her next baby. Several times in the next few days, he reassured her that her body was adequate and welcoming to have a future vaginal delivery. She has successfully VBACed at home and is expecting her next in October.

    Just as an aside, I was ENCOURAGED to take a movie camera into the operating room as this practice (who employs an excellent nurse-midwife) as their feeling is that if someone feels as one of these docs has done something wrong, he also has the proof on the movie of good care. My daughter had only four pain killers after surgery due to the fact that this cesarean was done very gently. I was amazed, since after 25 years of my own practice, I had seen some pretty awful things. I thank God every day for this practice and their open minds.

    Jenny Griebenow, if you read this, please e-mail me @ cdhmah@gmail.com. I think I know you from ICAN.

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