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: 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 […]
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? […]
On the acronym TOLAC (trial of labor after cesarean)….
Some studies break out statistics in four ways.
1. ERCS/D (elective repeat cesarean section/ delivery) 2. VBAC (vaginal birth after cesarean) 3. CBAC (cesarean birth after cesarean aka cesarean after planned VBAC) 4. TOLAC (VBAC + CBAC stats)
Because we are unable to predict who will have a VBAC or CBAC, the TOLAC stat enables us to review outcomes from a variety of angles:
TOLAC vs. ERCS VBAC vs. ERCS CBAC vs. ERCS
Some women find the TOLAC acronym offensive, because it implies “trying,” so practitioners sensitive to this may way […]
A mom recently asked, “I know I’m asking for a lot, but is there a list of rupture rates by weeks gestation ?”
This is a great question as many women are under pressure from their care provider to go into labor as early as 37 weeks, but more commonly 40 weeks, or they will have a repeat cesarean.
Let’s first look at what ACOG says in their 2010 VBAC recommendations,
Studies evaluating the association of gestational age with VBAC outcomes have consistently demonstrated decreased VBAC rates in women who undertake TOLAC [trial of labor after cesarean] beyond 40 weeks […]
Spontaneous labor is always preferable to induced or augmented labor but there are medical conditions that can necessitate the immediate birth of a baby. It’s nice for those women for whom vaginal birth is still an option to have a choice: gentle induction/ augmentation or repeat cesarean. Of course, informed consent reviewing the risks and benefits of their options is essential. Some women might be more comfortable scheduling a cesarean whereas others might want to give a gentle Pitocin and/or Foley catheter induction a go. […]
Some new research questions the idea that women who are “too posh to push” are responsible for America’s rising cesarean rate. The work of University of Arizona sociologist Louise Roth has been featured in an University of Arizona UA News article dated April 13, 2012.
Watch for Roth’s research which will be “published in the May issue of the sociology journal Social Problems, published by the Society for the Study of Social Problems.”
I’ve highlighted a few passages for those who like to skim.
By Jeff Harrison, University Communications, April 13, 2012
UA sociologist Louise Roth says the increasing […]
“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. […]
Conventional wisdom has historically linked oxygen deprivation during labor and delivery to cerebral palsy (CP), but a new study suggests that the majority of CP cases are actually due to genetic abnormalities in at least six genes.
A Medical News Today article dated January 30, 2012 discusses the study published in The Lancet Neurology:
Although there has been considerable improvements in neonatal and obstetric care for over 4 decades, the global prevalence of CP has remained stable at 2-3 per 1,000 live births.
. . .
David Ledbetter, Ph.D., chief scientific officer, Geisinger Health System, said:
“What we’re finding is […]
There is a reason why vernix is present. Read below for some very technical language which essentially says vernix protects newborns from fungi, parasites, and makes pathogens susceptible to our immune system. In other words, vernix protects newborns from infection which is why it is beneficial to not wash your baby and scrub away all that vernix, immediately after birth.
Published in the journal “Cellular and Molecular Life Sciences,” “Vernix caseosa as a multi-component defence system based on polypeptides, lipids, and their interactions” found:
Vernix caseosa is a white cream-like substance that covers the skin of the foetus and the […]
PushNews from The Big Push for Midwives Campaign CONTACT: Katherine Prown, (414) 550-8025, email@example.com FOR IMMEDIATE RELEASE: August 15, 2011 Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science Majority of ACOG Recommendations for Patient Care Found to Be Based on Opinion and Inconsistent Evidence WASHINGTON, D.C. (August 15, 2011)—A study published this month in Obstetrics & Gynecology, the journal of the American College of Obstetricians and Gynecologists, found that barely one-third of the organization’s clinical guidelines for OB/GYN practice meet the Level A standard of “good and consistent scientific evidence.” The authors of the study found […]
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.” […]
A couple weeks ago Virginia from Switzerland left this comment:
I am planning to have a vbac at a hospital in Geneva, Switzerland. In general, they are very supportive of vbacs here.
It is common practice here to measure the uterine scar at 37 weeks using a sonogram. Apparently, if the scar tissue is 3.5mm or higher – it is very unlikely for a rupture. Mine happens to be 2.95mm. The hospital staff tells me I have a 3 – 4% chance of a rupture versus a standard .05% chance of rupture. They warned me that I will be monitored […]