13 VBACs and Counting

I'm not sure how many people are fans of the TLC show 18 kids and Counting, but I LOVE it. I enjoy watching the Duggar family, and I think very highly of them. On the episode last night, Michelle and Jim Bob were celebrating their 25th wedding anniversary. They have been married for 25 years and have had 18 children in the process. The producers gave Michelle (the mom) the challenge of sharing about each of her children. They asked her to tell about each of their births as well as their personalities.

This is what I got from watching. I can't say that I'm 100% correct but it was my interpretation of what she shared.

Josh- Hospital birth with epidural

John David & Jana (twins)- C/S for pre-eclampsia

Jill- Natural VBAC

Jessa-Natural VBAC

Jinger- Home VBAC

Joseph- Home VBAC

Josiah- Natural VBAC

Joyanna- Natural VBAC

Jedidiah & Jeremiah (twins)-Natural VBAC

Jason- Natural VBAC
James-Natural VBAC

Justin- Natural VBAC

Jackson- C/S for breech presentation

Johannah- Natural VBA2C

Jennifer- Natural VBA2C

Jordan- C/S for transverse presentation

Michelle is a big supporter of VBAC and home birth, choosing to have cesarean sections only when it is medically necessary. I think she is a great example. It is amazing to see how many VBACs she has had even though some of Arkansas hospitals have VBAC bans.

Here is an excerpt from the Duggar family website where she discusses her decisions surrounding her births.

"As with any first time birth experience you might have fear of the unknown. As we approach each birth there are still the concerns of the unknowns such as the labor and delivery, each one has been different but having had the experience over and over does help some. Each time we have prayed for the health of mom and baby, and asked for a healthy, easy delivery.(As much as possible when were talking about labor!)

I’ve had three C-sections, one with our second birth, twins, Jana and John-David, with our 15th, Jackson and with Jordyn-Grace. All the rest have been vaginal births, 13 of which have been VBAC’s. (Vaginal Birth After Cesarean) We were hoping to have another VBAC with this last delivery.

I would say the greatest change that I have seen in the field of obstetrics, and I might add that it is very troubling to me, is the idea that once you’ve had a C-section you must have a C-section for any other pregnancy. It is much healthier for mom and baby to avoid major surgery and all the complications that go along with a C-section if possible. Granted, there are health situations that would warrant such, but for years obstetrics encouraged TOL (Trial Of Labor after previous C-section) with many successful healthy vaginal births. It was quite alarming to be told that I could no longer have a vaginal birth due to hospital or insurance companies regulations. It appears that what is best for the patient is not the priority with this decision.

I feel our health care is being jeopardized by this unhealthy approach. Doctors are having to tell their patients that they no longer offer VBAC assistance due to hospital regulations and some might even state to the patient that they are not safe so as to avoid confrontation. Statistics prove much differently.

For the many women that find themselves in this situation, ICAN is an organization that is very helpful in gaining more information on this topic. One of which I believe will be reversed in the near future as more women make a clear statement to health care providers and insurance companies as to how they would prefer to deliver there babies in a safer, healthier manner. (Now I will step off my soapbox!)
We are thankful our hospital allows trying a VBAC as long as they have an anesthesiologist on hand in case there is an emergency."

Michelle is expecting again, and I am curious as to whether or not she will have the support of her provider to attempt another VBAC after 3 c-sections.

It seems that for the most part, the option of having an elective repeat c-section is presented as if it holds no risk to the baby. Some women choose to forgo even attempting a VBAC, in order to protect their baby from any potential harm. We hear so much about the danger of VBAC and uterine rupture, to the point of where hospitals and doctors are refusing to offer it as an option. Yet, we hardly ever hear anything bad about choosing a c-section instead.

The truth is that they BOTH have risks. With both options there are no 100% guarantee of a healthy mom and baby. Because of this, mothers need to be well informed with what those risks are before they make their decision, and ultimately decide which risks she is ready to take. I have talked with women who have been scared by their doctors when it comes to trying for a vbac. They start to base their opinion of vbac on their doctor's fear instead on what is fact, or what they truly feel best about. My own OB/GYN informed me that "VBACs are way too risky," and yet didn't say anything about the risks involved with having another c-section.

It is very one-sided unfortunately, but the information is out there for those who care to have it. This is not to say that a mother would be wrong for choosing a ERC instead of a VBAC. I just think that women need to be completely informed about each option before they decide.

I personally, didn't know about the risks to my girls before I had my c-section. I know I signed a c-section consent form right before they wheeled me into the OR, but I can't recall what was on it. One of my daughters did end up in the NICU, which wasn't what we were anticipating. After learning more, I am not surprised that it did happen as babies are TWICE as likely to end up in the NICU following a cesarean section then after a vaginal birth. It's just one of the risks every mom should know about.

Repeat Cesareans may put babies at risk

This article can be found here.

AURORA, Colo. (May 22, 2009) – The babies of women who have an elective repeat Cesarean delivery are twice as likely to be admitted to the neonatal intensive care unit than babies of women who have a vaginal birth after Cesarean (VBAC). That’s according to a new study from the University of Colorado Denver School of Medicine.

The study shows babies born to women who have elective repeat Cesarean deliveries also continue to need oxygen in the neonatal intensive care unit.

“The costs of the birth for the mother and the infant are greater in the Cesarean section group,” according to the lead author of the study, Beena Kamath, MD, MPH, an associate professor of pediatrics at the University of Colorado Denver School of Medicine.

Kamath and researchers from UC Denver, Colorado School of Public Health and The Children’s Hospital looked at the records of 672 women who gave birth at University of Colorado Hospital. Each of the women had one prior Cesarean delivery. Three-hundred-forty- three decided to have another Cesarean while 329 planned a vaginal birth.

“Controversy exists on the recommended mode of delivery in women who have had one prior Cesarean section,” Kamath said, “It is important for women to discuss the risks and benefits of their delivery options with their doctor, and also to realize that the decision to have their first Cesarean section may affect the way they deliver if they have more children.”

The study appears in the June issue of Obstetrics & Gynecology.

AZ Woman Threatened With A Court Ordered Cesarean

This morning I saw this article on Facebook that was posted by Jill at the Unecessarean. It is originally from the Lake Powell Chronicle and it caught my eye, as I was born in Page at this same hospital. It is the ONLY hospital within 120 mile radius.

*I highlighted a few parts.

Hospital policy pains expectant mom

Posted: Wednesday, Sep 30th, 2009BY: Mary Forney — Lake Powell Chronicle

PAGE – A pregnant woman’s pleas not to have an unnecessary caesarean are being ignored by Page Hospital administrators.

Joy Szabo, 32, said she is upset with Page Hospital’s general ruling in June prohibiting vaginal births after cesareans (VBAC). The mother of three children, she has given birth to all of her children at Page Hospital, the only hospital in the immediate area. A placenta eruption caused her to have an emergency cesarean delivering her second child, but the hospital allowed her third child to be delivered naturally two years ago.Now pregnant with her fourth child, she is being forced to have a caesarean due to lack of hospital staffing.

“Page Hospital is, as many small communities are, challenged with resources,” said Chief Executive Officer Sandy Haryasz. “Page simply does not have the physician resources to respond to an emergency. Currently, we have two physicians who are delivering babies and a third physician will be joining us next week.

“Three physicians cannot provide the coverage recommended by ACOG (American College of Obstetrics and Gynecology). The physicians must be immediately available because of the risks of a VBAC and we cannot provide that in Page. In addition, we cannot provide an anesthesiologist to be readily available because we only have one anesthesiologist.”

Joy thinks it is against her legal rights to force her to have unnecessary surgery that might place her and her baby at greater risk of harm than delivering naturally. Her only option to having natural birth is to travel to a women’s care clinic in Phoenix or have unassisted home delivery.

While the hospital’s new policy not to do VBACs is unwritten, Haryasz said the decision is not based on money, but on there not being enough “volume” to warrant hiring another physician or emergency anesthesiologist.

“This is about providing quality safe care to all our patients,” Haryasz said. “The hospital would have to cancel surgeries or any other procedure because that doctor or anesthesiologist would have to be available to her while she’s in labor, which could take hours or days.”

Joy’s husband, Jeff, 44, is supporting what he thinks is his wife’s right to choose.

“I have talked with Banner Health officials who have said it’s just their policy,” Jeff said. “It’s a legal decision – not a medical decision. My wife’s plight is indicative of the health-care system in the U.S. They make money off of people’s suffering.

“Consequently, medical care is dictated by cost and insurance companies and not by what’s best for the patient.”Joy said she voiced her concerns at a board of directors meeting and has met twice with Haryasz.“I asked Sandy what would happen if I just showed up refusing a c-section and she said they would obtain a court order,” Joy said.

“They don’t want to allow VBACs because she said they aren’t equipped for emergency c-sections, but if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies – in case there is an emergency.“I wish her luck explaining to a judge that she is insisting I have a medically unnecessary surgery.”

ACOG currently supports VBAC deliveries, citing on their Web site at www.acog.org, that the benefits include the avoidance of abdominal surgery, shorter hospital stay, lower risk of infection, less blood loss, and less need for blood transfusions.The risks include a rupture of the previous cesarean scar during delivery, or in rare circumstances, rupture of the uterus.

Haryasz said that despite ACOG’s recommendations and the favorability of success with VBACs, Page Hospital is sticking by its decision to no longer perform natural deliveries after cesareans.“We respect our patient’s wishes should they choose VBAC, however the medical staff and administration have determined that deviating from national standards and performing this procedure here is a risk that is unwarranted and too great for our mothers and babies,” Haryasz said.The Szabos think that lack of staffing is not sufficient cause for Joy to be forced to undergo unwanted, unnecessary surgery.

“My doctor doesn’t have a problem with me having natural delivery, but said that the hospital does,” Joy said. “The fact that I successfully had a VBAC two years ago lowers my risk for rupture, but that doesn’t matter since the hospital has decided that all VBACs have to have an ‘elective c-section.’ I think my definition of ‘elective’ differs from theirs because I don’t want this.”