So I still get Time magazine. Every so often, there's something really worthwhile to be found in there. Like this article on repeat cesarean sections, and the trouble more and more women are having trying to find a care provider who will agree to attend a vaginal birth after cesarean (VBAC). In the 90's, VBAC was actually encouraged. But the trend has reversed. Fewer doctors are willing to attend VBAC, and some hospitals have right out banned them. Why?
"It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."
Often, the risk of uterine rupture is cited as a reason to avoid VBAC. However, there are lots of things that can lower that risk, including avoiding induction or pitocin augmentation during labor. And lets not forget that repeat cesareans come with their own set of risks.
With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop.
Ultimately, the choice should be up to the parents. They should be presented with risks and benefits of both VBAC and repeat cesarean, and able to make an informed decision. Often, this is not happening.
Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.
Pamela Paul, the author of the article, wrote the backstory to it in the Huffington post. Go read it here.
Even if a repeat cesarean section is necessary, care should be taken not to do it too early. Read here about the risks associated with early c-sections. The bottom line is, if you've had a cesarean section and are faced with a decision about what to do for future births, make sure you're well informed. Discuss the issue at length with your care provider. Find out not only their stance on the subject, but their actual VBAC and c-section rates. And if you do decide to (or need to) go for a repeat c-section, wait as close to your due date as possible, preferably even a trial of labor before to ensure baby is ready to be born.