A few unanswered questions regarding VBAC policy

As I read the reports from the NIH VBAC conference, I find myself asking a few questions I don't believe have been answered by our birth activism community or ACOG or NIH or anyone involved in this issue. As I will be spending a very considerable amount of time in the near future in a chair nursing a newborn, I am hoping to elucidate these questions.

1. Repeatedly we are told of the influence of care provider's insurance policies on a woman's right to VBAC and a hospital's decision to offer VBAC as an option. While I can appreciate the effect lawsuits from maternity patients and their families have had on these policies, to my knowledge no one has studied the circumstances of these lawsuits and how many of them directly resulted from VBAC complications. Are VBAC patients paying for lawsuits brought about by other maternal care issues?

2. While I know there is a growing and vibrant community of birth activists supporting a woman's right to VBAC, from personal experience most of my acquaintances with prior cesareans truly believe a repeat cesarean is safer than a VBAC. Are doctors deliberately fear mongering and if so what can be done to hold them accountable for this serious breech of doctor-patient trust?

3. What can be done at a national level to promote government policy that encourages healthier standards of practice for maternity patients?

NIH conference emphasizes safety of VBAC

Here are some of the positive findings from the NIH conference on VBAC held this week (we'll get into the negative issues surrounding informed consent/refusal that came up later):

"After reviewing earlier studies, the expert panel found that VBAC was about as safe as first-time vaginal childbirth. "

"According to the new panel, uterine rupture occurs in less than one percent of the women who attempt VBAC, and fewer than 4 in 100,000 women die. While uterine rupture is more rare in repeat cesarean, the risk of maternal death is about three times higher. Women who undergo several cesareans also seem to have a higher risk of having their womb removed."

Long story short: VBAC deaths - 4 in 100,000, repeat c-section deaths - 12 in 100,000

"Despite the enthusiasm surrounding VBAC, surveys have shown that as many as one-third of US hospitals and half of all physicians will not perform it."

Why? Because most hospitals dictate that there must be a full surgical staff and OB on standby for the entire labor.

But wait a minute, shouldn't any hospital that provides obstetric services have that available? What happens in the event of an emergency that requires a cesarean under other circumstances? It seems a little prejudicial to deny one women who is at no higher risk of needing a c-section vaginal birth while allowing a first time mom to labor and attempt vaginal delivery.

Many doctors claim this is dictated by insurance policies, but why those insurance policies overlook this obvious flaw is troubling. And perhaps the best way to combat this issue is to get our insurance companies involved. After all I'm guessing your HMO would rather pay for a vaginal birth than a cesarean, which can cost 4 times as much and result in a much longer hospital stay.

In the end, you have a right to say no to repeat cesarean, but you have to be willing to change doctors and possibly hospitals.

Read the full report from Reuters here: http://www.reuters.com/article/idUSTRE62952Y20100310

When life hands you hospital birth...

you make hospital gowns. Well, you do if you are Ms. Craftipants. It's a good stress reliever to design something and it allowed me to do something productive.

But I know you aren't here to hear about the hospital gown. You're wondering what horrible complication has resulted in the need to transfer to the hospital. Well, truth be told there isn't one. Take a deep breath, we're all fine. It's just been a series of small discoveries about my last birth with James that has culminated in deciding to play it safe with our first VBAC. Believe me, I want #3 to be born at home!

I have warning signs of preeclampsia for starters. We've managed to keep my blood pressure down and my protein levels at a reasonable level, but, and I won't bore you with all the bloodwork details, it could go anyway. I am eating a very high protein diet to keep my levels good and swelling at bay and trying to remain active enough to keep my blood pressure down. This is easier said than done with the weight of a watermelon strapped to your belly.

The other concern is that I'm a VBAC, which wouldn't really concern me, and honestly still doesn't. However, the genius that closed my c-section only did a single layer suture. I'm a little mad about this still and have channeled my energy into sewing. I've gotten a lot done the last few weeks. While a VBAC is still much safer than a repeat c-section, the single layer makes my husband and my midwife nervous. Quite frankly, it doesn't scare me at all - maybe I'm too tenacious for my own good. However, I really respect their need to protect me and to feel comfortable during the process. I need them to be able to focus and not worry, because in the end the VBAC is the most important thing for me.

So the plan is: labor at home, transfer before transition, and push the baby out at Overland Park Regional. I hope they have nice rooms.

To get psyched for hospital birth:

I've made a labor gown and a gown for afterwards. They are much cuter and better for breastfeeding. I am aware they will get gross. I sooooo do not care. I have literally dozens of yards of fabric that needed a good use.

I picked out Syd's coming home outfit and crocheted an adorable cotton hat with felted wool flower to match.

I reminded myself that while I am recovering I will get food brought to me from the friendly hospital staff. You know like really mediocre room service!

And I remind myself that no matter what happens, this birth will be better. This time I empowered and informed. And at the end I will have a beautiful baby girl, 9 months of fantastic prenatal care, and a different perspective on childbirth.