Monday, April 12, 2010 at 11:30AM
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Reader Comments (22)
Pardon my French, but HELL YEAH!
Things *have* to start changing sooner than later....
I have had 4 VBAC's now and really hope that successes like mine help to convince folks that VBAC is safe! My last two were home births...and the last one in January of this year was an 11 pounder...if I can do that safely at home, then others can, too! OB's, insurance companies and hospitals need to realize this and make VBAC the FIRST option woman are given!
Is that the entire article? If so, sounds good, but I wonder if it's one of those bait-and-switch things? Sometimes by the end of an article like that you are left with the feeling that VBAC is an option for *some* women, IF their OB thinks it's a good idea, and only if they are so against RCS that they are willing to take on the **RISKS**, KWIM? Kinda back-handed.
^^ I can vouch for the 11 pounder. He is a sight to behold, and his mama truly is an inspiration.
So happy to see this in the EPITOME of mainstream parenting magazines - turning of the tides indeed!
Wow, how wonderful to see this in such a mainstream publication! Now if we can just get them to stop saying VBAC is "high risk," which naturally implies that the alternative is "low risk" or at least less risky. I think recent publicity surrounding rising maternal mortality, along with the overall positive outcome of the NIH conference, is combining to bring VBAC back into public view. I'm very hopeful that we'll start seeing the pendulum swing back toward VBAC, and, yes, as Justine said, start making VBAC the *first* option.
I read the article just yesterday. While it is great to see VBAC getting some mainstream press, the full article does tend on the "doom and gloom" side. The sub-headings in the rest of the article talk about who are the best candidates for VBAC and include such great ones as "You Watch those Pounds" - here's what it says:
"If you were slim when you became pregnant and haven't gained a lot of weight since, your chances of a problem-free VBAC are higher. "Being overweight doesn't rule one out, but the increase of soft tissue around the pelvis may make it harder for a baby to come through the birth canal.""
Now I'm all for VBAC awareness (especially as I am hoping to have one in just 4 weeks!) but seriously, what kind of a comment is that? Sorry I don't have the capabilities to scan in the article.
WOOHOO!!!
Oh man: " but the increase of soft tissue around the pelvis may make it harder for a baby to come through the birth canal."
I suppose they don't provide ANY cite for that?? I mean, whoever put this in--do they know that fat is *outside* the uterus, in fact, right where a surgeon would be cutting...? Which actually seems to argue for a VBAC and NOT a c/sec if you're overweight at all.
I was thinking the same thing as Michelle. I think I already tossed this issue. I just read the crafts and the "It Worked For Me" then throw it out. I've read too many articles that seem good, but then end up spreading misinformation. Reading the articles is bad for my blood pressure.
I have been listed as a top rated Doc in parent magazine so BEWARE the misinformation! That said, let's look at this. Vbac shold be the first option for most and not at all for some. Providing the c/section was necessary (sorry, gotta say it) and the factors that were present then are resolved, why not? The risks are low but since the chances of rupture are above baseline it is considered high risk - sort of. After the first vbac I have never seen a rupture. Find the stats on that Jill! Would I let a repeat vbac deliver at home. Can't say yes (PC), won't say no. I have seen two vbacs rupture, both first vbacs and both poor candidates but not contraindicated. I could go on for ever on the good/bad candidates but it might seem like teaching. That's what Jill's for. And since when did the Doc accept the risk? I talk to you, you sign the permit. It is the moms choice/privelege/bain to accept the risk. I get to sit around a monitor and watch TV. If it was the old days I would probably go kill small animals with sharp sticks.
Yes obesity can create a soft tissue dystocia but it is of the birth canal. Nothing to do with the uterus. Usually does not stop dilation but can halt descent. Where normally if you give time, edema will compress and allow delivery, swollen adipose tissue only gets worse and is a bitch to sew up. The vagina exerts about 90mmHg pressure (primip, for Mrs. Duggar - zero) on the fetus. This supposedly increases with morbid obesity but I'll be damned if I can find where it was tested (and I absolutely do not want to know how!!!). Obesity should have nothing to do with vbac choice and I find it odd it was mentioned in this article. Now, tilt 90 degrees and remember, obesity = elevated risk diabetes, macrosomia, soft tissue dystocia, increased bone/muscle attachments (spines) and more android pelvis occurance (hard tissue dystocia) so maybe they were just vectoring into a la la land but actually got close. Again beware the "lay" publication. H**l, beware the non-lay ones.
Jill invited me.
I did invite Ob to comment whenever he likes. If I did not do this, he would be killing small animals with sticks for sport and I can't have those tablespoons on tiny, tiny animal blood on my hands.
There were a few more pages of the article. Emily, who sent it to me, told me that it was fairly neutral but didn't mention anything about spontaneous labor vs. induction.
lol...anything to keep Ob from killing small animals! Really, I like Ob. It's nice to see a doctor on here who has pretty reasonable things to say and doesn't tell us that our birth trauma is all in our heads or only because we're white or whatever.
Just for the record, I despise "parenting" magazines ;) Mothering magazine is my only exception.
I've known many overweight women who gave birth vaginally... Many of the women in a birth group I belong to are larger women - and they're not just vaginal birthing but home birthing. Our c/s rate in that group is 13% (many are due to prior c/s and the active recent c/s rate is more like 3% of about 300 members... and many of the c/s that I HAVE seen in this group were due to malposition or the c/s was unnecessary after a transfer)! There's also actually an entire website devoted to large pregnant women!
I've known many large women who ate plenty of good food (ie: Brewer's diet etc), exercised, lost weight, and were fine -- I think some of the time women are in denial that their size could affect their pregnancy. When they accept it and attempt to make changes, I'm positive this generally improves the outcome.
I cannot speak for large women tho as I am a 100 pound bean, but I will defend the larger women from this article anyway!
Regardless, I think that this article must have been written by an ignorant man. The author knows NOT of natural birth or its benefits, or c/s and its risk, and so they write like "VBAC is great but not for this woman and this woman and that woman and those women etc. etc." when it actually should be "VBAC should be the general rule, not the exception.. and.. what about reducing the primary C/S rate in the first place with those ridiculous candles, that aromatherapy, the Beatles in the background, or just generally respecting women and the natural process of birth in the first place" ?! Ehhh they'll never write such in a "parenting" magazine so I shall not anger my eyes by reading such!
Yes, it was a positive article about VBAC. But it also had many cloaked messages.. yes.. instill more fear.. just what pregnant women in our society need.. Argh.
Of course, I am sleepy so probably not making a ton of sense.. perhaps my commentary will be better next time. ;)
Hopefully that is the case...I stopped subscribing to Parents a long time ago, but hopefully the writer presented it in a fully unbiased manner that looked at both sides of the issue. And the truth of the matter: that sometimes finding doctor support is difficult, and they will do whatever they can do dissuade you. (But that could be a liability, I guess) As a writer, I get SO frustrated when I only hear one side of the coin in stories like this, and even though it looks like an important topic is finally hitting the mainstream parenting circles, it does a great disservice by not being completely honest and forthcoming - thus doing more harm than good.
I may have to check this out. Thanks for the heads up!
Ahh, that pregnancy Web site for larger women referred to is by the ever-excellent Kmom: http://www.plus-size-pregnancy.org/
I love the attention given to the VBAC option, but women still need more providers willing to give them an honest shot at it and to objectively discuss their options and chance of success. I also hate how these articles always lead with uterine rupture and either ignore or downplay the surgical risks of a C-section in current and future pregnancies.
I read that article last night. While I admit i must grudgingly give Parents a hat-tip for even mentioning VBAC, like most of their articles, it comes across as quite one-sided (like the article on vaccines in the same issue). They list all the HORRIBLE! DANGEROUS! SUPER DUPER RISKY (but probably kinda rare, we think, I dunno, BUT OMG RISKY)! things that can go wrong, and then go, yadda yadda, yeah, it's probably safer.
What I STILLLLLLLL don't get is why they say VBAC is dangerous because too many Cesareans are dangerous. Okay. This is not logical. Don't have a vaginal birth because the more Cesareans you have, the higher your risk of complications. So, have another Cesarean. WHAT?!? Does not compute!
Also, I really like OB. :D Now that is the kind of Good Doctor whose comments I won't mind reading!
Something I never see discussed in VBAC articles: The risk of VBAC rupture is ~1%. The risk of never-had-a-Caesarian rupture when the woman is given a reasonable amount of Pitocin is ~1%. But no one is changing hospital policy saying that Pitocin should only be used sparingly, or that women should have a C-section rather than be given Pitocin. Yet the very same figure (1%) is causing hospitals/docs/insurance companies to freak out and deny VBACs.
"the uterine rupture rate has been documented...as...0.5% to as high as 1.8%. The major point of difference between the high and low numbers is whether or not the labor was induced or augmented with prostaglandins and/or Pitocin." http://www.collegeofmidwives.org/prac_issues01/VBAC_waiver_2003.htm
Larissa, in my institutions (great name for hospitals) which constitutes 5 delivering facilities of around 2400 beds (total) the vbac rupture rate (primary vbac) runs 2-3 % depending on the facility. Only the teaching hospital and me are left offering this option. The teaching facility has soveirgn immunity and does some weird things. The rupture rate for spontaneous no problem labor, and I stress no problem so don't pull any criteria here, is almost unmeasurable though it does occur. Augmented/induced/provoked/poked at/whatever labor rupture rates are virtually unmeasurable because the indications/drugs/regimines/unreported/misreported/etc are hard to pin down. Everyones stats on this suck so I have to guess when I tell patients it is around 1%. How's that for flying by the seat of ones pants/skirt (do skirts have seats?)? No one gets to claim right on this stuff. I have to do it by observing and tempered opinion from reading. What are the new practicioners and the lay public supposed to do?