Vaginal Birth After Cesarean on the Decline
Are forced C-sections the future of your child’s entrance into the world?
Ten years ago, I had my second child and my first vaginal delivery, or what is known as a VBAC,* a vaginal birth after cesarean. It was all I had hoped for with my second baby, as my first delivery was an unexpected and frightening emergency C-section.
Today, had I been pregnant with my second child, I might not have been able to go the VBAC route, and personally, I would have been disappointed if I hadn’t been given the opportunity to try. In a world convoluted with malpractice suits and wrongdoings, and lawyers ‘he-saiding’ and ‘she-saiding,’ the VBAC is fast becoming a thing of the past.
So is it safe to assume that women are being forced or ‘coerced’ into thinking a repeat C-section is better for them and for their babies? Somebody must be telling them this. Time.com reported that “more than nine out of 10 births following a C-section are now surgical deliveries.” A 2005 study by Childbirth Connection, a 91-year-old maternal-care advocacy group, indicated that 57 percent of women who had a C-section were interested in the option to have a VBAC but were swayed from doing so.
Is this a case of OBs looking out for themselves, or are they concerned about the well-being of their patients? As Time.com reported, much of the hesitation on the parts of the OBs to conduct VBACs is the scare of a malpractice suit and the costs involved in the procedure. In 1999, the American College of Obstetricians and Gynecology mandated that in order to prepare for a VBAC, a hospital must have surgeons and anesthesiologists “immediately available” rather than “readily available.” This puts additional costs on the hospitals and on the doctors. I wonder if today’s doctors are looking at birthing babies as a business — why spend hours waiting for a woman to deliver her baby vaginally if a doctor can convince her to schedule a nice, quick, hour-long surgery, thereby eliminating extra staff and the possibility of an emergency situation?
If my OB had indicated that a VBAC was not an option, I would have found another doctor, one who would listen to me. One who would be concerned with the way I had hoped my labor and delivery would go, although, as I knew from the birth of my first child, nothing is guaranteed. I didn’t want a doctor who would be apprehensive to let me have my baby the way babies are supposed to come out of a woman’s body just because he would fear something might go wrong and I would sue him.
The International Cesarean Awareness Network Fact Sheet states:
“Deliberately performing unnecessary surgery in the belief it avoids lawsuits is indefensible. That many obstetricians seem oblivious to the profound violation of ethical principles is shocking.”
It can’t be stated any clearer than that. I don’t know what doctors promise to do when they become doctors, whether they take an oath or learn the code of ethics, but I thought making sure their patients are cared for in the best possible manner would be at the top of their list. And forcing or convincing someone to choose an option she might not necessarily be comfortable with is definitely unethical in my book.
As with anything, there are risks of VBACs, the main concern being uterine rupture, but if a woman goes into labor spontaneously, that risk is less than one percent. With my third birth (and my second VBAC), I was 11 days overdue, and while I begged to be induced, my OB would not permit it because induction could cause stress on the uterus, which could cause a rupture. So, I waited it out in hopes of another successful VBAC at the advice of my doctor.
Of course, there are absolutely times when a VBAC is not an option:
• Your first labor was long and difficult, and you experienced slow cervical dilation.
• You have a small pelvis (and although I am not in the medical field, nor have I ever played a doctor on television, I personally disagree with this).
• You have genital herpes.
• There is fetal distress.
• You are pregnant with twins.
• You have diabetes or high blood pressure.
There are far more risks involved in having a cesarean than a VBAC, some of which may include: blood loss, hemorrhaging, hysterectomy, bladder/bowel injury, incisional endometriosis, heart/lung complications, blood clots, anesthesia and surgical complications, reduction of possible breastfeeding establishment, compromise of psychological well-being and emotional trauma, among others. The International Cesarean Awareness Network indicates that even premature and at-risk babies born by cesarean fare worse than those born vaginally.
If you’re in a predicament with your pregnancy and are not sure which route to take, it’s absolutely worth having a talk with your OB. The main point is that you have a doctor you trust and who knows your history and your birth philosophy, and that you are both in agreement with how you want to deliver your baby.
When I got pregnant with my second child, I did my homework. I knew I was capable of dilating and pushing because of my first labor. But I am also fully aware from personal experience that sometimes things can go wrong and that a vaginal birth may not always be the best or safest delivery option.
But to be told that a woman is not even going to be allowed to TRY to deliver her child through her vagina because of a slight risk (which to me, is the doctor saying, “We’re scared something can go wrong and we don’t want to be sued”) or because of an inconvenience to hospital protocol or because they need to get additional staff on board … well, that’s just wrong. Not only is it wrong, but it’s also unethical – and women should stand up for their rights to birth the way nature intended.
*For more information on Vaginal Birth after Cesarean, or if you’ve been denied a VBAC, visit www.vbac.com.