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Q&A: Single vs. dual layer suturing

pregnant-belly---hands---man

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 […]

VBAC: A husband’s experience and lessons learned

Young Laughing Father and Child  Having Piggy Back Fun.

 

“I have just seen so many women who have husbands who aren’t supportive because they don’t understand. My husband would love to help more men understand.”

A couple recently shared their VBA2C (vaginal birth after two cesareans) journey with me.  It touched my heart.  My the time I was done reading it, I had tears in my eyes.

So many women do not feel that VBAC is an option for them because their partner isn’t on board.  Now I know there are women who will birth how they please regardless of their partner’s feelings or thoughts, but there […]

OB front office staff doesn’t know what a VBAC is

Businesswoman Outdoors on Cell Phone

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. […]

Thoughts on VBA3+C (VBAC after three or more prior cesareans)

Childhood Girls

A mom recently asked over on the VBAC Facts Community, “Does anyone have some facts on vab3c?” I provided this mish-mash of info… […]

Emotional healing from traumatic births

Sad Teenage Girl

So many women are carrying the emotional baggage of their traumatic births. This unprocessed anger and disappointment can negatively impact how future births unfold. Women often feel betrayed and lied to by the medical establishment while simultaneously wondering if their bodies are broken and incapable of birth. […]

VBAC bans, exercising your rights, and when to contact an attorney

Gavel and Law Books

“Does the hospital have the right to stop contractions and section the patient? This is what I’m hearing in my birthing community and I really cannot believe a hospital would/could do that.” […]

Myth: VBACs should never be induced

IVdrip

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. […]

The best compilation of VBAC/ERCS research to date

“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? […]

Confusing fact: Only 6% of uterine ruptures are catastrophic

questionmarkwoman

How many times have you heard “Only 6% of uterine ruptures are catastrophic” or “Uterine rupture not only happens less that one percent of the time, but the vast majority of ruptures are non-catastrophic?” But what does that mean? Does that mean only 6% of uterine ruptures are “complete” ruptures? Result in maternal death? Infant death? Serious injury to mom or baby? This article will explain to you the difference between uterine rupture and uterine dehiscence as well as explain the source and meaning of the 6% statistic. […]

Placenta problems in VBAMC/ after multiple repeat cesareans

elevatorup

I thought that I would take the data from the Silver (2006) that I’ve previously discussed and share it in a different way that would be helpful to women with multiple prior cesareans.  (You might find it worthwhile to read this article specifically, where you can view the data below in graphs, as well as other articles on placental abnormalities first.)  Remember that accreta is when the placenta abnormality deeply attaches into the uterus requiring surgical removal.  There is a 7% maternal mortality rate with accreta as well as a high rate of hemorrhage and hysterectomy.   One of the […]

Options for mom who will be “forced” to have a repeat cesarean

legal

I just received this email tonight and need ideas quick. This term mom seeking VBA2C is in the the Columbia area of South Carolina. Her OB was supportive until 37 weeks. Her cesarean is scheduled in two days on March 5, 2012. She was told that if she shows up in labor, she will be “forced” to have a cesarean. Does anyone know of a care provider in her area that would be willing to accept a new client this late in pregnancy? What other options does she have? Additionally, I’m looking for information on the legality of a hospital/OB “forcing” a c/s? What happens if she shows up at the current hospital and refuses to sign the c/s consent form? What exactly CAN they do?? […]

Studies find pregnant women with prior cesarean choose the delivery method preferred by their doctor

definition decision

“When patients perceived that their doctor preferred a repeat cesarean, very few chose to undergo trial of labor, whereas the majority chose trial of labor if that was their doctor’s preference.” Additionally, 73% of the women admitted for a ERCS did not know the chances of a successful VBAC and 64% did not know the risk of uterine rupture. 54% of women choosing a TOLAC did not know the chances of a successful VBAC and 45% did not know the risk of rupture! […]

Mom encounters VBAC ban and requests advice

hospital-vbac-bans

A mom seeking a VBAC runs into major roadblocks at her local hospital which has a VBAC ban. VBAC Facts compiled a list of options based on real live decisions of women who VBACed despite bans. Did you deliver at a VBAC ban hospital? What was your strategy? Are you a health care provider at a VBAC ban hospital and have some insight? […]

Myth: Risk of uterine rupture doesn’t change much after a cesarean

myth versus reality

1/18/12 – The difference in uterine rupture (UR) rates between unscarred and scarred uteri is significant: 1 in 14,286 in an unscarred uterus and 1 in 156 in a scarred uterus.  Another way to express this is: 0.7 in 10,000 (0.007%) in an unscarred uterus and 64 in 10,000 (0.64%) in a scarred uterus.  This 91 times greater risk does not mean that the risk of UR is so large in a scarred mom, it’s that it’s so very, very small in an unscarred mom.

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I came across a couple different bits of (mis)information […]

Do intrauterine pressure catheters make VBAC safer?

internalmonitor

A mom planning a VBA1C (vaginal birth after one cesarean) at a Southern California Kaiser recently emailed me. She discovered while interviewing her care provider and asking how they treat VBAC labors differently than non-VBAC labors (an excellent question), that they require intrauterine pressure catheters (IUPC) in all VBAC labors. She wanted to know what I thought of their policy.

As I read more and more about IUPCs, I was increasingly curious why they would be required.  The evidence for their ability to predict uterine rupture is lacking and as a result major OB/GYN associations do […]