Once a C-Section, Now a VBAC

Julie Marsh
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birth by c-sectionIt used to be that if a woman gave birth via c-section, any future births would also be via c-section. The concern was that labor and vaginal delivery could rupture the c-section scar, putting both mother and baby at risk.

Now that c-section incisions are made horizontally and near the pubic bone (as opposed to vertically and higher up on a mother's belly, like they used to be), a vaginal birth after a c-section is often a viable option. According to a recent article in the New York Times, "about 70 percent of women who have had Cesareans are good candidates for trying for a normal birth, and 60 percent to 80 percent of those who try succeed."

So why are VBAC rates dropping and c-section rates increasing?

A National Institutes of Health conference panel examined that same question. They found that while the risk of a VBAC is very small, "a scheduled Cesarean is slightly safer for the baby." Additionally, multiple studies have shown that the possibility of a malpractice lawsuit is a factor in increased c-section rates.

Given those staggering malpractice premiums -- in some states it's over $200,000 a year -- and our lawsuit-happy culture, I can hardly blame doctors for protecting themselves. They're also trying to protect their patients, even if VBAC activists don't see it that way.

Still, it's not always the doctor who has the final word on recommending a c-section over a VBAC. The professional societies of anesthesiologists and obstetricians have issued practice guidelines that "require that surgical and anesthesia teams be "immediately available" during labor if a woman has had a prior Cesarean. Some hospitals, unable to comply, banned vaginal birth after Cesarean." The NIH conference panel recommended that both organizations review these guidelines.

The idea, of course, is that doctors who practice in hospitals that can't meet these guidelines will now be able to offer their patients VBACs. But revising the guidelines won't make a difference in malpractice premium rates, which means that many doctors -- particularly those in states where premiums are highest -- will continue to recommend c-sections.

Full disclosure: I'm contributing to the increase; I've had three c-sections. Two of those c-sections were in New York, where premiums are among the highest in the country.

Do I wish I'd tried for a VBAC? Honestly, no. After my first c-section, which I hadn't anticipated and was mentally unprepared for, I realized it didn't really matter how my daughter had made her entrance -- the important part was that we were both safe and healthy. When I was pregnant for the second and third times, my doctors (I've had three different obstetricians) recommended a scheduled c-section at 39 weeks, and I agreed.

Birth -- whether surgical or vaginal -- is never without risk. Bad things happen to mothers and babies, and they're not always foreseeable or preventable. I remember looking up at the glaring overhead lights as I was prepped for my first c-section, realizing that even though it was highly unlikely, my baby or I could die. It was extremely sobering.

While I trusted and accepted my own doctors' recommendations, I support women who want to have a VBAC. I understand the desire to experience labor and delivery, as well as the desire to minimize intervention in what is usually a routine and always an amazing event.

And in the end, I wish us all healthy and happy babies.

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