VBAC: A Woman's Choice

Bravo to OBGYN!  They're taking their heads out of their keesters and changing the guidelines to repeated C-sections.  "Once a cesarean, always a cesarean" is going the way of bloodletting.  According to a recent report, the American College of Obstetrics (ACOG) is easing restrictions on which women will be allowed to have a vaginal childbirth following a previous cesarean.

It has been the policy of the ACOG to deny women the choice of a vaginal childbirth in order to prevent uterine rupture at the scar from the previous surgery.  However, the chance of this actually happening is less than 1%.

Despite the low risk, most obstetricians and hospitals insist on performing the riskier surgery.  In fact, the number of women going through "vaginal birth after cesarean," or VBAC, has gone from 3 in 10 fifteen years ago to less than 1 in 10 today.

"Why?" you might ask.  Because the rare uterine rupture could lead to emergency C-sections, and many smaller, rural hospitals are not equipped to perform them.  Emergency C-sections are much riskier than planned ones, and in ill-equipped small hospitals, it could be life-threatening.  Add to this a few high-dollar lawsuits and no surprises that the choice of VBAC has been denied to many women.

The numbers don't lie though, and c-sections are expensive, so the National Institute of Health (NIH) strongly urged steps to reverse that trend that saw one third of hospitals and half of doctors banning VBAC.  Talk about no choice.

Dr. William Grobman of Northwestern University and co-author of the guidelines said women's choice is "what we want to come through loud and clear....there are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making."  Indeed, good doctor.

Nearly one third of all births is by cesarean, and even the most medical-worshiping patrons must admit...this number is very high.  Although C-sections can be lifesavers in some cases, they do, in fact, increase the possibility of complications in the next pregnancy, some life-threatening, like placental abnormalities or hemorrhage.

The ACOG in its wisdom states that C-section scars are now located on the lower part of the uterus, further diminishing chance of rupture during VBAC.  And of those who attempt VBAC, say the ACOG, between 60-80% will deliver vaginally.  Of the 20-40% that do not...well, they'll get a C-section.  No harm, no foul.

I realize what a touchy subject this is among doctors and women.  I am reminded of a previous post where a reader lambasted me for not understanding the discomforts of pregnancy and labor because, had I, I would not be so glib in badmouthing C-sections.  Sheesh...I didn't realize how some people just want a quick knife and be done with it.  I get it now.

But here's the beauty of it for you women who despise the natural way of furthering the species: You can still have your choice of a planned cesarean.  Can't fathom the push and contract?  No problem.  C-sections are available.  But for the women that actually would like to connect with nature, the restrictions were BS, and now they can try without some doctor denying them their rights.  So you get yours, they get theirs, and we're all one big happy family.

ACOG did right.  Bravo to them.

Home-birth or Not

There's a new trend sweeping the nation, and that's home births--Au natural. Many women are opting for a more relaxed, less sterile experience and home births are it. Home births are typically aided by a midwife, a practitioner that provides pre- and postnatal care as well as attending the birth itself. Aside from their skills in labor and delivery, midwives are trained in recognizing and dealing with any deviations from the norm. For the most part, they are hired to assist in low-risk pregnancies and childbirth.

Today's costly medically-assisted deliveries, where non-cesarean births can run as much as $20K ($35K+ for a C-section), a cheaper alternative is sorely needed. This is especially true for women who don't want the accompanying drugs; and at a fraction of the cost (approximately $3,000), midwife-assisted home birth might just be the perfect option.

Great--let's recognize and certify midwives, and even better, let's make home births reimbursable. Not so fast, Campos--home birthing and midwifery have some pretty powerful opponents, specifically the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG). The arguments against home births are questions of safety and training. The AMA and ACOG just don't respect the current level of training of midwives, and they stress that the absolute safest way to have a baby is through the monitoring and observation of a hospital staff, period.

Hmmm....you know, this debate isn't about safety or training at all--it's about control. Not control of people, but of an industry. It's the same old same with the AMA. They want complete authority over all matters health. If it ain't supervised by Big Papa, it ain't hapnin'. Sorry. Any healthcare professionals practicing "on the fringe" of the mainstream deal with this reality on a daily basis; but is it based on truth?

Home birth or hospital birth is a choice. Obviously higher risk pregnancies should be managed where the pros who deal with that stuff operate. However, lower risk pregnacies in relatively healthy women can be experienced joyfully in the comfort of one's home. Hey, I'm no hippy--my wife and I had our girls at Cedars Sinai (she liked the cocktails way too much to pass up that option). But it was simply a choice--not better, not worse--just how we wanted to do it. Looking back, we could have easily done it at home with a midwife. Frankly, my wife did all the work. The nurse watched. I napped. And the OB walked in like a rock star for the last half hour, yelled "push", and pulled the baby out--something a midwife could have done just as well, only cheaper.

Our hospital birth was cool; I enjoyed the experience. My wife got her fix, and we got to eat hospital food. And we had good insurance so we didn't end up paying that much. But for people who don't have great insurance; or for those who want a more serene birth (ours wasn't rough, mind you--I got to watch lots of ESPN and presidential debate highlights, while Erika was a pack of Pall Malls short of a party), a home birth is a nice option.

Elective C-section May be Hip, but...

Birth by cesarean section (c-section) has doubled in the last ten years. Statistics show that one in three American babies is now delivered by cesarean. A c-section is a form of childbirth where a surgical incision is made through a woman's abdomen and uterus to extract the baby (or babies). While many of these procedures are medically necessary--to save the life of the mother or baby--a large number of women are electing to have cesarean sections as their first option, that is, without trying to deliver vaginally. In fact, elective c-section is all the rage in Hollywood today, with many a young starlet opting for one (or two as is purportedly the case with this out-of-control Hoochie Mama).

But, once again, I must point out that surgery is not without risks. This is especially true for the now routine c-section: Recent research shows that babies delivered by non-emergency c-section have a four times greater chance of having breathing problems. According to Anne Hansen of the Aarhus University Hospital, Denmark, one of the lead researchers in the study, the greatest risk is seen when the procedure is performed early on--before the 39th week of pregnancy. Therefore, she states, if a woman is going to elect for this procedure, it probably shouldn't be done before this time. It is as of yet unclear why babies born by cesarean might have breathing difficulties, but researchers believe that stress hormones produced by the mother during labor actually help the baby's lungs mature.

C-sections, without a doubt, are a blessing to any family who has had the horror of experiencing a dangerous labor. There was a time when either mother or baby, or both, might be lost during difficult birthing. Thanks to c-sections, though, many lives have been spared; and probably everyone reading this has a loved one in the world today because of this blessed procedure. But saying that, isn't it a shame that so many women are choosing not to experience the incredible process of giving birth the old fashioned way? Aside from the bond that is established between mother and child during this laborious process, there must be physiological, hormonal, and--excuse my metaphysics, but--energetic benefits to the entire process. To just bypass this most natural act, this integral part of our evolution, seems a bit detached to me. What's next? Portable colostomy bags? I mean, what the heck--it's uncomfortable and...I really can't be bothered, so...sheesh.

Listen, this isn't a morality trip but, unless you know it'll be a hazard to your health or the health of your baby, don't opt out of the beautiful birthing experience. The labor is worth the pain. It was by far the greatest experience my wife and I have ever had (yes, better than mushrooms and whiskey, much better). And besides, it turns out it's better for your baby too.

Check out this blogger's hysterical take on elective c-sections.

And something on the more serious side.