Diff. between C-Section and Natural delivery

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Cathlete
I am pregnant for the second time. My first child was breech, so I had a cesarean. With this pregnancy the baby is not breech and everything has been going very well. My doctor insists on doing another cesarean. She claims "it's safer and VBACS are rarely practiced".
Has anyone else heard this? Or, does anyone know of a good website to find out why doctors seem to push for sections?
Thank you for any information you can share.
Susan C.M.
 
This is copy and paste from a pevious response I posted... too lazy to retype. :)

I remember several years ago VBACs were "it", but OBs and hospitals are a bit more hesitant with VBACs. There is a fear of litigation, because if there is a uterine rupture the outcome is often catastrohpic and there will most likely be a lawsuit. The physician and/or the hospital may end up in court.

There is also the issue of medical malpractice insurance costs that are rapidly increasing and will definitely increase if the physician has been involved in a medical malpractice lawsuit. In fact, there are some malpractice insurers that won't cover VBACS. In addition to the cost of malpractice insurance, the American College of Gynecology has a new new standard of care for VBACs that requires "a full surgery team (including a surgeon and anesthesiologist) to be immediately available during labor and an operating room kept open". This is an expense some small hospitals just can't afford.

You can find more written on the subject by googling VBAC and malpractice.

ETA: I live in a small town and some of the OBs do not perform VBACs, so this is common in my part of the world. ;)

HTH!

Autumn
 
You may want to look at the book "the VBAC COmpanion" and also take a look at the ACOG guidelines for VBAC. I had a VBAC in 2002, but my most recent pregnancy was a repeat c/s. I went by the "guidelines" and my OB was supportive of a vaginal birth as long as we "went by" the guidelines. the big concern for ob's (other than the malpractice issue) is the risk of uterine rupture.

The guidelines more or less state that a woman should be permitted to VBAC with a whole lot of "restrictions".

For me, the restrictions were: a hospital with 24 hour access to surgical service, I had to start labor spontaneously, no pitocin or cervical ripeners, and I couldn't go to far beyond my due date. I was almost at my due date with a suspected big baby, so off for the c/s I went.

I suggest learning as much as you can about the statitistics of uterine rupture and making your case for a VBAC, if that is what you want (you're probably a good candidate because your first was a breech). If your ob isn't on board, consider a second opinion, preferably with a dr. at a larger teaching hospital.

good luck. It's a difficult decision. Kristan
 
Hi,

I just had my second son on 9/17 - I had a failed VBAC. My first son was breech like yours (I actually went into labor and then had the c-section). I was told I was a great candidate for a VBAC. A lot of doctors don't do them anymore because of malpractice risks. But they are fairly common in my area. I went into labor this time around (started out with my water gushing in the middle of the night in bed!). I never progressed. So, I had the c-section. There is about a 1% chance of uterine rupture which could result in mom and baby's death. I'm glad I had the c-section because a section of my scar had thinned significantly. I think seeing it scared my doctor because he had given me the option of trying pitocin for a few hours, and my scar would not have held up to that if I would have went that route (plus my little man was face up which would have been a bad labor). Many people have successful ones though.... This c-section was a lot easier than the first (still hurt, but maybe I just knew what to expect!). Good luck to you!

shelln
 
I and my friend both have had two successful VBACs. I have never heard that VBACs are rarely practiced, honestly I haven't. It has been six and a half years since my first VBAC and since I had a successful one they didn't really worry about my last pregnancy. I know that it increases your risk of uterine rupture (by up to three times, from 1:600ish to 1:200ish) and the fact that doctors are hesitant to do them because of malpractice makes sense. It is possible to have a successful VBAC, though, and I am honestly happy that I got to have two, and happier that I pushed for the first one. Another reason why a doctor would want to push a c-section is because of convenience.

HTH,
Missy
 
It depends on location to some extent. In parts of the country where malpractice is a significant problem, the malpractice issue will weigh in heavier to a physician's decision. I have heard doctors say that they won't deliver VBAC because of malpractice.. not so much the risk of uterine rupture itself as I touched on briefly earlier. And of course, if a physician can not obtain liability insurance he or she isn't going to do them. Then of course, there are the ACOG guidelines. Rural hospitals often don't have the facility and staff to meet the ACOG Guidelines. Sorry to keep going on and on about the malpractice but it is a HUGE problem (potential problem) in some parts of the country. There are states with physician shortages (ie., OBs) related to the malpractice issue.

Every woman VBACed a few years ago, and I never (thankfully) witnessed a uterine rupture. How times change. It is sooooo frustrating that malpractice, patient insurance companies, etc. influence our care. It should be about what is best for the patient not the pocket book. I am such an idealist. :)

Listen to Kristan, research and then question your doc.
 
Autumn, malpractice insurance is a HUGE problem, I agree. My step-dad is a cardiologist and in the past ten years his insurance premiums went up from 16,000 a year to over 80,000. I can't imagine what it is for OBGYNs.x(

ETA that I don't know one person who has had a c-section who has experienced a uterine rupture and has attempted VBAC, not to say it couldn't happen

Missy

(now look who's stalking ;-) )
 
Thank you all for your replies and information. I found it VERY useful.
Susan C.M.
 
Just wanted to add my experience too.

I had a failed VBAC with my second daughter two years ago. My labor was only 1 hour w/2hours of pushing and she wasn't pudging, so off I went for my second c-section. My doctors and nurses were supportive of me trying but in the OR my ob did say my uterus was paper thin and all he had to do was push his finger through it. That was a little scarey! But I do know that even now in my area it is very hard to find a hospital that will allow you to try anymore. Most ladies would need to go to mid-wife.

Good Luck!
Mary:)
 
Susan:

My first child was by c-section. I got pregnant one year later. During the 2nd pregancy my doctor scheduled me for a c-section. I told him I'd rather try a natural delivery. He was very supportive. 21 months after my C-section I had a VBAC.

Looking back I realize that I was depressed about my c-section. I felt I had failed and I didn't get to "experience" child birth. To be honest a lot of other women made me feel that way too. So, I was determined to have the perfect birth story for my second child. It was silly.

After my VBAC I realized that it doesn't matter how the baby comes out. I'm serious -- whether it is your vagina, your belly -- goodness it wouldn't matter if the baby came out of your nose. You are pregnant, you created a life, you will carry that baby for 9 months and raise that child for the rest of your life. Those few moments of "giving birth" really doesn't matter as long as you and your baby are healthy. You see, neither way was easier, or better, just different. Nothing else.

So - I say, do your research, talk to your doctor. And do what is healty for you and your baby. There is no right or wrong way to have a baby.

I hope this helps. I felt bad about myself for a year. I only wish I would have been lucky enough to have all the supportive women that you have on this forum to explain to me that a c-section isn't a failed attempt at childbirth! Now, years later, I have two healty kids and I gave birth to them both!! :)

Take care,
Michelle
 
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