It’s important to use clear, specific language when we talk about birth because there is a lot of confusion among moms, advocates, doulas, and health care providers about VBAC and induction. When I point out the lack of clarity many people have on the topic to “anti-induction advocates” (for the lack of a better term), they respond with the fact that their focus is warning moms about elective inductions, which is absolutely needed. And they genuinely believe that people are aware of the distinction between elective and medically-indicated inductions. However, that has not been my experience, in fact it’s been quite the opposite. There are many people who don’t understand the why, when, and how of inducing VBACs and that is impacting the abilities of women to make informed decisions and exercise their right of patient autonomy.
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 use among pregnant women. There are only two studies that examine the oral use EPO and its ability to ripen the cervix during pregnancy. There are no studies on the vaginal use of EPO. In short, there is insufficient clinical evidence documenting the risks and benefits of EPO and without that information, the question is, should pregnant women take it?
Becky recently ask this question on the VBAC Facts Community:”I read somewhere that the risk of uterine rupture is actually higher during pregnancy than during birth. Does anyone have a source for this?”
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.
Some care providers discourage epidurals in VBAC moms fearing that it will mask the symptoms of uterine rupture (namely abdominal pain) and delay diagnosis resulting in a poor outcome for baby and to a lesser extent, mom Other care providers suggest or even require VBAC moms to have an epidural so that a cesarean can quickly take place if needed.