VBAC calculators have been embraced with open arms by some providers, whereas others reject them altogether. Who’s right? Trying to predict who will have a VBAC is tricky. We know some individual factors, such as having a prior vaginal delivery, are associated with higher or lower VBAC rates. By combining various factors, VBAC calculators generate a percentage that represents the best guess for an individual’s odds of having a vaginal birth after cesarean. But VBAC calculators, also called VBAC success calculators, are not always accurate and can create emotional baggage.
In 2011 a woman with two prior cesareans named Rinat Dray was forced to have a cesarean at Staten Island University Hospital in New York. She sued the hospital and two physicians for ‘improperly substituting their judgement for that of the mother’ and ‘pressuring and threatening her.’ During the course of her lawsuit, it was revealed that this hospital had a secret forced cesarean policy. When I learned about this policy, I was shocked. Yes, forced cesareans happen. They are woven into the culture of some hospitals as are other forms of obstetric violence. But to have a formal, written policy saying that it was OK?
When I found out that ACOG released their new guidelines yesterday, I couldn’t wait to devour them. This morning, I had an opportunity to cuddle up with the new recommendations and I’m quite pleased. As always, there are things to like and areas where I think ACOG missed the mark. But here are the eleven good things about ACOG’s 2017 VBAC guidelines.
I’m in an online group for labor & delivery nurses where the discussion of vaginal birth after cesarean (VBAC) at home came up. While some understood the massive VBAC barriers many women face, others simply said, “Find a hospital that supports VBAC.” I left a late-night comment stating that “finding another hospital that supports VBAC” is just not a reality in many areas of the country. It’s literally not possible. Not even in the highly populated state of California. I also suggested rather than calling women stupid or debating the validity of the decision to have a home VBAC , we should consider why women make this decision.
“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.”
The statistic “Only 6% of uterine ruptures are catastrophic” is from the Evidence Report (Guise 2010) which was the basis of the 2010 NIH VBAC Conference and it refers to the rate of infant death due to uterine rupture.