March 15, 2010
Why Most VBACs Are Denied
A blue-ribbon panel of physicians, midwives and other healthcare providers convened at the National Institute of Health to discuss the dilemma of vaginal birth after cesarean (VBAC). At the end of the three-day-conference, they issued a statement that read: “Given the available evidence, TOL (trial of labor) is a reasonable option for many pregnant women with a prior low transverse uterine incision.” Most obstetricians know that, however convincing the hospitals is another matter.
The vacillation of VBAC policies makes me dizzy. In the late eighties and early nineties there was a tremendous effort to promote VBACs and dispel the myth of “once a cesarean section, always a cesarean section.” I recall the days of my residency training when we would call hospitals in foreign countries in an attempt to document a uterine incision of a pregnant patient who had one previous cesarean section and had presented to our hospital in labor. To section or not to section, was the issue at hand. If a woman had a vertical uterine incision, then she must have a repeat cesarean section to avoid the possibility of rupturing the uterus. However, is she had a low transverse or horizontal incision, than ideally, she was a VBAC candidate, barring any other issues such as more than two cesarean sections, fibroid surgery (aka myomectomy) and other uterine procedures that are too complicated to mention.
I blissfully remember taking care of a patient with two previous c. sections who presented in labor at 8 centimeters. She ultimately had a successful VBAC and I was greatly relieved. I dreaded doing repeat c. sections. Fighting layers of scar tissue (adhesions) from previous surgery is not a pretty sight when you’re attempting to reach the uterus and deliver a healthy baby.
Today, most hospitals will not allow VBACs unless the physician remains in the hospital during the patient’s entire course of labor. Since most physicians refuse to do so, a patient is forced to have a repeat c. section. When you deny a woman’s freedom of choice, please be prepared for the consequences. VBAC activism is on the rise and I hope it continues to spread.
RJ said,
March 15, 2010 at 5:23 pm
Thank you for posting this. As a mom and an VBAC-tivist, I find that although many docs are willing to support a woman’s choice to have a VBAC, few are willing to speak up for it (and are ultimately rather apathetic about it.) Thank you so much for adding your voice to those who truly care!
drlindagalloway said,
March 15, 2010 at 10:25 pm
Thanks for taking the time to respond. In the end, it will be YOU, the patients who will win this battle. Keep the pressure on!
Elizabeth Regan said,
March 20, 2010 at 12:52 pm
Thanks for posting this… I wish more people knew the truth. Unfortunately there are so many people screaming for c-sections, I fear that nothing is going to force change in this arena. I will continue to hope. For me, I found my answer to a Vaginal Birth after two ‘unnecacesareans’ in the comfort of my home with the most amazing midwife in the world. There is no doctor who would have stuck with me for 36 hours of seemingly unprogressive labor. But my midwife did and I am sooooo thankful. I delivered my third child at home in my bathtub after 36 hours of my very first labor! Most triumphant thing I have ever done!
drlindagalloway said,
March 20, 2010 at 12:56 pm
Thanks for responding, Elizabeth. I’m so happy your third delivery was a success. Physicians don’t have all the answers. Life is very much a work in progress. Keep up your activism! Believe or not, the powers that be ARE listening.
Sophie R said,
March 24, 2010 at 1:58 pm
I had to fight to obtain a VBAC, and the supports groups such as ICAN were a great help. I had to change physicians, as my initially supportive physicians got cold feet. It was the best decision I’ve ever made. I didn’t want an epidural, as I felt it would be safer, but I used a fantastic hypnosis technique called Hypnobabies, and l was very relaxed during labor, which was virtually pain free. Being very relaxed meant more safety as well.
I was lucky to find a very supportive team including a doula, an OB and a hospital all familiar and confident about VBAC.
It was safe for the baby, safe for me, and also… What a difference it makes to recover quickly and be able to bond with your baby right away, as opposed to being unable to walk for 2 weeks!
theresa said,
April 6, 2010 at 5:44 am
The new healthcare bill will not allow for this type of choice…. There will be a chart with directives to doctors about how to deliver babies….. it will call for the cheapest, fastest way possible. – We can say good-bye to pain reducing medications too…. It won’t be considered cost effective or necessary for deliveries. Babies born earlier than 32 weeks…. they won’t be considered viable due to cost benefit ratios…..
Are you sure you support Obama Care…. you should probably (re-)read the bill…. slower this time…. without the blinding “super-star” glare coming off of Obama distracting you.
drlindagalloway said,
April 6, 2010 at 12:38 pm
The only reason I’m responding to your post is because I want to dispel the mythology that you’re disseminating. There is NOTHING in that bill that dictates whether a patient should have a VBAC or C. Section. That decision is made solely by the patient, the hospital and her physician. And as far as being “distracted by the Obama-star,” nothing could be further from the truth. I am not happy with all of our President’s policies but I express my opinion in a respectful and intelligent manner. I don’t use cheap scare tactics and I’m not zenophobic. And don’t put words in my mouth. No one called Dr. Cassell “stupid.” However, when an American pre-med student attends a foreign medical school, especially in the Caribbean, it is usually because they were not accepted by a US med school. And you’re missing the entire point of the post. Most physicians, having trained on indigent patients, do NOT give back once completing medical school. I did. Did Dr. Cassell, or for you for that matter?
SaanenMother said,
April 9, 2010 at 12:56 am
ha ha ha ha ha ha Theresa what a comment!
Glad to see you have already read the entire health care bill and are now giving summations in public discussion forums.
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