Wednesday, May 6, 2015

Vaginal Birth After Cesarean (VBAC)

It hit me just how long it has been since I have kept up-to-date with posting in this blog. I do apologize! I am still in practice in Southern Utah, and my clients keep me busy! 

We just wrapped up Cesarean Awareness Month last week. In case you don't follow me on Facebook, here are my posts to bring about awareness regarding both cesarean section and vaginal birth after cesarean: 

Did you know that approximately 1 in every 3 women in America who walk into the hospital to give birth, walk out healing from major abdominal surgery?

Did you know that a cesarean for "big baby" is actually not a valid medical reason, and is advised against by the American College of Obstetrics and Gynecology, based on empirical research?
Did you know that according to research, most complications during labor that lead to a cesarean are iatrogenic (physician or procedure caused)? This includes cord prolapse, cesarean for nuchal cord (cord around the neck), fetal distress, hemorrhage, and more

Did you know that not only is Vaginal Birth After Cesarean (VBAC) possible, but that it's statistically low risk? The main concern with a VBAC is uterine rupture, which has a likelihood of 0.3-0.7%. This means that you are 99.3-99.7% likely to NOT rupture.
Being in a birth setting which is conducive to complete support and facilitation of VBAC is the most important aspect, beyond researching the ins and outs of it all. Unfortunately, many care providers and hospitals have policies and procedures which reduce your likelihood of a successful VBAC. Not because it can't be done, but because of the "rules" that often come with VBAC. Sadly, many care providers are not up to date with research in this area, and have restrictive rules surrounding VBAC labor.

Did you know that a VBAC after more than one cesarean is not only possible, but still considered relatively low risk? I have attended women who have had 2 cesareans, and have a current client who has had 3.
The largest research conducted on vaginal birth after multiple cesareans showed a uterine rupture rate of between 1-1.7%. The American College of Obstetrics and Gynecology position statement on VBAMC say that women who have had 2 cesareans with low-transverse incisions should not be discouraged from planning a vaginal birth.

Did you know that your chances for a successful VBAC lie with the rules your care provider might have for VBAC labor/birth, rather than your inherent ability to give birth vaginally?
Restrictive (and non-evidence based) rules such as scoring "well" on a trial of labor success scoresheet (where they take into consideration your age, weight, reason for previous cesarean, whether you've had a vaginal birth, etc), going into labor prior to 40 weeks, needing to dilate at the rateof approximately 1cm per hour, consistent monitoring, epidural (some require this), and the type of closure you had during your last cesarean.The American College of Obstetrics and Gynecology does not limit their recommendations for encouraging VBAC in women with 1-2 prior cesareans to these things, yet Obstetricians and Midwives (even home birth midwives!) restrict to these things. Make sure you know your care provider's beliefs about VBAC, and what rules they may have in labor and birth. How do they feel about VBAC? Are they hesitant, worried, even afraid? Do they know what the research says about VBAC risk and benefit? Find someone who knows these things thoroughly, and who is experienced and comfortable with VBAC.

Did you know that not being dilated or effaced by your due date is NOT an indication that you are not likely to have a successful VBAC? Though this is often said as a stipulation to "allow" (gotta stop allowing people to "allow" you in birth, ladies!) you to have a trial of labor, it is not evidence based. Dilation only tells you what your cervix is doing at that moment. That's it. Normal gestation length (38-42 weeks) applies to VBAC moms as well, and some may need longer.
Waiting does not increase your risk of rupture.

Christine Fiscer is a Traditional Midwife in Southern Utah who has been entrenched in VBAC research for over ten years. She has been attending VBAC and VBAmC (vaginal birth after multiple cesareans) at home for eight years. 

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