A mom recently asked over on the VBAC Facts Community, “Does anyone have some facts on vab3c?” I provided this mish-mash of info… […]
While these statements are very comforting, as birth myths tend to be, they are false comparisons. We can accurately and fairly compare the risks of a TOLAC to the risks of a repeat cesarean or the risks of a first time time. However, it is a misleading to compare the risks of birth to non-birth events. […]
What a miracle this woman survived! This was her fifth baby and fourth cesarean.
She had a complication known as placenta percreta which is when “the placenta attaches itself and grows through the uterus, sometimes extending to nearby organs, such as the bladder” (March of Dimes 2012). The risk of having placenta accreta, increta, or percreta during a fourth cesarean or a VBA3C (vaginal birth after three cesareans) is 2.13% (1 in 47) (Silver 2006).
Most women planning a VBA1C (vaginal birth after one cesarean) are aware of the risks of uterine rupture. However, women planning their first vaginal birth […]
“There is a major misperception that TOLAC [trial of labor after cesarean] is extremely risky” – Mona Lydon-Rochelle MD, March 2010. “In terms of VBAC, “your risk is really, really quite low” – George Macones MD, March 2010. Both Drs. Macones and Lyndon-Rochelle are obstetricians and researchers who made these statements at the 2010 NIH [National Institutes of Health] VBAC Conference. Now you may think, “Wait a sec. Everything I’ve heard from my family, friends, and medical provider is how risky VBAC is and how cesareans are the conservative, prudent, and safest choice.” Why the discrepancy between the statements of these two doctor researchers and the conventional wisdom prevalent in America? […]
If primary and secondary cesarean rates continue to rise as they have in recent years, by 2020 the cesarean delivery rate will be 56.2%, and there will be an additional 6236 placenta previas, 4504 placenta accretas, and 130 maternal deaths annually. The rise in these complications will lag behind the rise in cesareans by approximately 6 years. […]
Per Silver (2006), “The risks of placenta accreta, cystotomy [surgical incision of the urinary bladder], bowel injury, ureteral [ureters are muscular ducts that propel urine from the kidneys to the urinary bladder] injury, and ileus [disruption of the normal propulsive gastrointestinal motor activity], the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries.” […]
There is this idea that if you don’t VBAC and you schedule a repeat cesarean, that you will be safe from complications. This is because during a “VBAC counsel,” women are often told of the risks of VBAC, namely uterine rupture, but they are rarely told the risks of repeat cesareans in their current and future pregnancies.
Abnormal placental implantation is one risk of cesareans that only present themselves when you get pregnant again.
Women who expect to only have two children, and thus opt for a repeat cesarean, might think that not VBACing is the safer, and more controlled […]
This article published June 19, 2009 demonstrates one hospital’s experience when they changed their oxytocin (Pitocin) protocol.
I’ve included the entire article below and have emphasized what I consider to be the most interesting parts.
Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries By Betsy Bates Elsevier Global Medical News Conferences in Depth
CHICAGO (EGMN) – The modification of the oxytocin infusion protocol at a large university-affiliated community hospital nearly halved the number of emergency cesarean deliveries over a 3-year period, reported Dr. Gary Ventolini.
As oxytocin utilization declined from 93.3% to 78.9%, emergency cesarean deliveries decreased from 10.9% […]
This is a great piece for deciding between VBAC and repeat cesarean. Those who wish to VBAC, but have husbands, family, and/or friends who don’t understand why, might find this document very useful. I have found that people who are anti-VBAC really seem impressed by what doctors and medical organizations have to say, so I’m thinking they will find this document compelling. Plus, VBAC has this reputation of being “risky” and repeat cesareans are thought of as the “conservative approach,” and this document challenges both lines of thinking. Why not write a sweet little note like, “I know you are […]
This is a comprehensive article on adhesions which is a fancy word for scar tissue. I think the most relevant points of this whole discussion are:
Adhesions “develop in 93% of people who have undergone pelvic surgery” and “they are especially common after cesarean sections.” You get more adhesions with each cesarean. Adhesions can cause: Pelvic or Abdominal Pain Bowel Obstruction Infertility Adhesions impact future cesareans by making the surgery longer which can put your baby at risk in an emergency situation (emphasis mine): “If you have had a cesarean section and are pregnant or planning to have another child, […]
We all know the primary risk of VBAC – uterine rupture. And when your typical VBACing mom meets with an OB, she must sign a “VBAC consent form” acknowledging that she understands this risk. However, I find it ironic that women signing up for a repeat cesarean are not required by their OB to sign a “Repeat Cesarean Section consent form” as a matter of course during prenatal exams since there are risks associated with cesarean section. But since this does not happen, and most OBs breeze over the risks if they even bother to mention them, expectant moms are […]