Over the last five years Dr. Stuart Fischbein, a Southern California obstetrician, has attended 135 home births. These deliveries included VBACs, vaginal breech and vaginal twin deliveries.
A summary of these births has been recently published.
Here are some highlights along with a few additional resources I compiled where you can learn more.
On patient selection:
“This model was not limited by strict protocols and allowed for guidelines to be merely guidelines. Women over 35, VBAC, breech and twin pregnancies were not excluded from this series simply because those labels existed. Each client was evaluated on her own merits and the comfort of the practitioner.”
Q: “I know the risk of uterine rupture is 1-2% during a VBAC, but do you have any statistics for the risks of a repeat cesarean?”
A: The risk of uterine rupture after one prior low transverse cesarean is 0.4% – 1% depending on whether the VBAC labor is spontaneous, augmented or induced (Landon, 2004). Spontaneous means labor begins naturally. Induced means the woman is not in labor and is given a drug to try to start labor. Augmentation means labor has already begun and drugs are used to make the labor progress more quickly.
Cesareans carry increased risks of […]
Q: Is there any evidence to support double layer suturing over single layer?
A: Conclusive evidence on single vs dual suture does not exist. Also note that ACOG does not say one form of closure is better than another in their VBAC guidelines.
Bujold (2012) stated, “Although there is a growing body of evidence that the technique for uterine closure can be crucial for uterine scar healing, strong evidence regarding optimal techniques is scarce and there currently exist no national or international guidelines on which obstetricians-gynecologists and surgeons can rely.”
Bujold provides a good review of the literature, so you […]
I apologize for not writing in so long. I’ve been busy with various projects including producing my 6 hour program “The Truth About VBAC” to be released online this summer! Subscribe to my newsletter to be informed of this and future classes!
I’ve been responding to many questions over on my Facebook page and have been trying to think of ways to archive those discussions here for future reference. Then the obvious answer appeared… post the questions and answers here and link back to the original question posted on Facebook! So, here we go! I look forward to blogging more […]
There has been a lot of confusion regarding AB1308, the legislation that went through at the beginning of this year in the state of California. It said that LMs were no longer allowed to attend home births some situations (such as breech, beyond 42 weeks gestation, etc) and other situations required a physician to sign off on the home birth.
It’s these regulations that are currently being written by the Medical Board with input from ACOG, CAM, CFAM, and VBAC Facts. It is under discussion whether a prior cesarean should be included on this list of conditions that would necessitate a […]
I’m so excited to announce a new series on VBAC ban reversals. My objective with this series is to show that hospitals do reverse their bans and to give other hospitals a blueprint for how they can do the same. So, if you work for a hospital that has reversed their VBAC ban and you would like to share your experience with other hospitals via vbacfacts.com, please contact me. Submissions can be anonymous and do not need to provide the hospital’s name. […]
Trying to find a VBAC supportive health care provider can be (very, very) difficult process. Understandably, some women choose to call various providers rather than meet with them face to face. This woman’s experience illustrates the pitfalls of this method. […]
I was recently interview by Roanna Rosewood of Birth Plan Radio. You can listen to the show here. Below you will find links where you can read more about the various topics discussed.
The history of VBAC bans
Jen’s unique form of advocacy.
ACOG’s 2010 VBAC recommendations
The various documents related to the 2010 National Institutes of Health VBAC Conference
Birth myths, specifically on inducing VBACs, how the risk of uterine rupture differs between women who have had a cesarean and those who haven’t, and how the risk of rupture compares between induced, unscarred moms and scarred moms.
I hear a lot, “What’s the big deal about cesareans? What difference does it really make if you have a cesarean?” Of course, if a cesarean is medically necessary, then the benefits outweigh the risks. But in the absence of a medical reason, the risks of cesareans must be carefully considered. […]
Many moms and midwives use evening primrose oil (EPO) for cervical ripening. So I was absolutely shocked at the complete lack of evidence on the effectiveness and safety of EPO among pregnant women. There is one study that examined the oral use EPO during pregnancy. It concluded EPO didn’t work as we expected it to and further, women who took EPO were more likely to experience a whole host of complications. Shockingly, there are no studies on the vaginal use of EPO during pregnancy. In short, there is insufficient clinical evidence documenting the risks and benefits of EPO and without that information, should pregnant women take it? […]