Posted by My OB said WHAT?!?.
Mar
2
Posted by My OB said WHAT?!?.
“…Having Another VBAC Would Be Very Dangerous.”
“The more VBACs you have, the more likely you are to have a uterine rupture! Having another VBAC would be very dangerous!” – OB to mother seeking care for her fourth vaginal birth after cesarean (VBAC.)
There are 33 comments to this post.
Wait, she’d already had 3 VBACs? And nothing happened? The scar held up during THREE labors? And didn’t rupture? Soooooo, when is the dangerous part starting? I’m so confused!
Related question: Does the scar need to be manually checked internally after a VBAC? They did that to my friend (pure agony), and after doing research I’m still not sure if it was necessary or just ‘standard procedure’.
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Knitted in the Womb Reply:
March 2nd, 2010 at 7:34 am (Quote)
I’m so sorry on behalf of your friend. I had a client who had her placenta manually removed when she was unmedicated–which would be the same pain. It was aweful.
No, the research does NOT support manually checking the scar after a vaginal birth if there is not excessive bleeding for which a source can’t be found.
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Sheva Reply:
March 2nd, 2010 at 7:38 am (Quote)
There was practically no bleeding at all. The baby came very fast, in my car, actually, and except for one tiny smear, there was no blood in my car at all. So I guess it was uncalled for, like I’d originally thought.
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Knitted in the Womb Reply:
March 2nd, 2010 at 11:28 am (Quote)
Some care providers do this “routinely,” so that might have been what happened to your friend. Or your friend could have been being “punished” for not getting to the hospital in time for them to convince her to have a cesarean.
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Michelle Potter Reply:
March 2nd, 2010 at 7:58 am (Quote)
Wow. No, I *never* had anyone manually check the scar after any of my VBACs. That would be pretty horrible.
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Michelle McClafferty Reply:
March 2nd, 2010 at 8:12 am (Quote)
This is part of being in an “involuntary clinical trial”. Beware, it happens all the time with women and children.
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Michelle Potter Reply:
March 2nd, 2010 at 11:25 am (Quote)
What is? Having your scar manually checked, or not having it manually checked?
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Michelle McClafferty Reply:
March 2nd, 2010 at 11:38 am (Quote)
Having the scar checked. This [research] is where “they” get the info that over half of the “ruptures” are just a thinning of the scar that successfully ended in a safe vaginal birth.
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Sheva Reply:
March 2nd, 2010 at 11:52 am (Quote)
Are you saying that they consider ‘scar thinning’ a rupture and include it in their rupture statistics?
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Michelle McClafferty Reply:
March 2nd, 2010 at 12:30 pm (Quote)
Absolutely!
0.6% – uterine rupture rate – spontaneous onset of labor
0.5% – dehiscense – thinning of scar or section of uterus area & opening of scar without any maternal or fetal consequences
0.1% – maternal uterine rupture with uterine hemorrhage and fetal compromise including death
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Heather Reply:
March 2nd, 2010 at 1:33 pm (Quote)
Definitely not supposed to be standard procedure (doesn’t mean it isn’t). Mine was checked because I had excessive bleeding. It didn’t hurt, btw, and I’d just had around 16 stitches (8 of which were without any painkiller, so I was freaking sore) from a 3rd degree external tear and a large cervical tear. My baby came out really fast, too.
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Michelle McClafferty Reply:
March 2nd, 2010 at 6:00 pm (Quote)
I didn’t mean it was standard practice to check the scar of a VBAC, just that it does go on and we should always be aware of what and why things are done to us. I have been told by doctors “off the record” that such things are done often times just because they (the doctor) were just curious…. nice!
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Heather Reply:
March 2nd, 2010 at 6:10 pm (Quote)
I missed your comment, I was just responding to the original, but wow@the “just for curiosity”. Of course, I’m curious, too, so I didn’t mind knowing that my scar was basically perfect. Who knows why the excess bleeding, it stopped before I needed any back or anything, but there was a surprising amount. But if it was just for the doctor’s curiosity, that would cheese me off.
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I was told this by my midwife’s back-up OB when pregnant with my 7th child (6th VBAC). “You should schedule a C-section. With every pregnancy your scar is getting weaker.”
We moved 1500 miles away during that pregnancy but I mailed him a copy of the study done at Case Western Reserve showing that the more VBAC’s a woman has the LESS chance she has of a rupture.
For the record, that baby was a VBAC despite pre-eclampsia, as was the baby after her and am planning VBAC #8 in June 
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Michelle Potter had this to say,
Mar 2, 2010 @ 11:38 am (Quote)
This is another one of mine. My first baby was an unnecesarean, then next three were VBAC. I was calling around looking for an OB to deliver my 5th baby. One doc gave me this line of BS over the phone. I said thanks, but no thanks, and hung up.
I *almost* got in to a birthing center with this pregnancy. A local center was about to start a study on the safety of VBAC in birthing centers, and they said I’d be perfect. But the study was canceled right before I called due to politics. 
One of my biggest regrets about my unnecesarean was that I was never able to give birth in a birthing center after that.
I ended up with a c-section with #5. I do believe it was necessary, though, and I labored for 12 hours first with a very VBAC friendly doctor who specifically told me during labor that we should exhaust all other options before opting for another cesarean (and we did!)
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Heather Reply:
March 2nd, 2010 at 2:09 pm (Quote)
That’s too bad, I’m hoping for a birth center birth with my next VBAC. The closest birth center is about 45-60 minutes away, but they will take VBAC if the woman has had at least one vaginal birth, so I wasn’t a candidate there with my first VBAC, but I am now
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Michelle Potter Reply:
March 2nd, 2010 at 2:20 pm (Quote)
I’m glad you will be able to get your birthing center VBAC! 
I’ve been told that “the climate is bad” for VBACs in Houston because a baby died. This had to have been at least 7 years ago, because I’ve been told the same thing every pregnancy since my 2nd baby. Personally, I’m very sad for the family who lost their child, but I think it’s a pathetic excuse for a ban, considering this is the 4th largest metropolitan area in the country, with supposedly the best medical center in the world. It’s just inexcusable that the home of Texas Children’s Hospital and MD Anderson Cancer Center doesn’t follow the evidence on VBACs.
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Heather Reply:
March 2nd, 2010 at 2:26 pm (Quote)
That’s ridiculous! It’s awful, but how many babies die in hospitals every year? THEY don’t get banned for birth.
Until the year before last, midwives could be arrested in MO (my state) for catching babies. After decades of fighting for it, CPMs are now legal for homebirths I hope your area wises up, too. It was too late for me to find a midwife for a homebirth for my VBAC, but I could conceivably have one next time. But I’d rather go to the birth center and get waited on hand and foot 
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Heather P Reply:
March 2nd, 2010 at 7:22 pm (Quote)
I got waited on hand and foot at home. My MIL was there and she was amazed that my midwives treated me like a queen. My husband grinned and said, “Makes you wonder why people go to the hospital doesn’t it?” We had a homebirth convert.
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Heather Reply:
March 2nd, 2010 at 7:53 pm (Quote)
I know most people feel great at home and I know I would have with my first (still kicking myself for not doing it), but now I’m stuck at home almost 24/7, so this isn’t much of a restful place for me anymore. However, I’m still on the fence between birth center and home. Depends on how a few factors play out between now and when I get to that place again.
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Heather P Reply:
March 3rd, 2010 at 7:58 am (Quote)
Happy birthing to you Heather. It’s great that you have that option now in MO. Whatever your choice may be.
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Heather Reply:
March 3rd, 2010 at 4:51 pm (Quote)
Thank you and yes, it’s a hard-won battle, though it’s not done. Lay midwives can still be arrested, unfortunately, and CPMs live in fear of the law being reversed, so many aren’t willing to take up insurance or advertise until it’s more secure. It already got briefly overturned once
I had a wonderful OB with my second birth, who believed in birth and women’s choices, who supported me when I requested to go against hospital policy and catch my own baby, but it was still a hospital birth, with nurses controlling me against my will, threatening me when he wasn’t there… So not ideal, though it was much better than my first.
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The Wellrounded Mama had this to say,
Jun 3, 2010 @ 11:12 am (Quote)
The first commenter had it right; the doc’s textbook was upside down! It’s the exact opposite of what he says.
The doc is probably concerned that having a certain number of pregnancies might increase her risk for uterine rupture (UR). Grand multiparity is a risk factor for UR in third-world countries in unscarred women, so they reason it must be an added risk factor in women with scars.
However, a look at the actual research shows that grand multiparity is probably not a signifciant risk factor for UR in women with a prior cesarean, and that the risk for UR actually significantly decreases after a prior VBAC.
Other recent research shows pretty conclusively that having multiple VBACs actually has much better outcomes than multiple repeat cesareans.
I understand the reasoning behind his concern, but if he were familiar with the research at all, he would know that in fact, a prior VBAC makes you one of the best candidates for a TOL that there can be…..a lower risk for UR and a very high rate of VBAC success.
Sometimes you have to wonder whether docs read their own research literature at ALL.
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*turns the doc’s textbook right side up* There you go. You just had it backwards.
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Jane Reply:
March 2nd, 2010 at 10:45 am Jane(Quote)
LOL! I love this.
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The Deranged Housewife Reply:
March 2nd, 2010 at 2:54 pm The Deranged Housewife(Quote)
HAHAHAHAHA I literally laughed out loud when I read your comment.
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Heather P Reply:
March 2nd, 2010 at 7:09 pm Heather P(Quote)
You win Jena!
LOL
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