Saturday, February 12, 2011

Reuters Report: New Guidelines Say Vaginal Birth Okay After C-section

Wed, Jul 21, 2010 (Reuters Health) — Even if they aren't staffed to handle emergency cesarean sections, hospitals should respect a woman's informed choice to have a vaginal birth after cesarean (VBAC), new guidelines say.

VBAC is known to increase the risk that the scar left in the womb from a previous cesarean will tear during labor, leading to massive bleeding that can threaten the baby's life. That has led to previous guidelines urging caution for women who have had cesarean sections.

But recent research shows so-called uterine rupture occurs in less than one percent of women who opt for vaginal birth, and that between 60 and 80 percent of VBACs are completed successfully.

While the new guidelines from the American College of Obstetricians and Gynecologists (ACOG) still say a full surgical team should be present in case an emergency cesarean is required, they now put a bigger emphasis on the woman's decision.

"Respect for patient autonomy supports that patients should be allowed to accept increased levels of risk; however, patients should be clearly informed of such potential increase in risk and management alternatives," they say.

"For most women with a previous cesarean delivery, a trial of labor is a safe and appropriate option," said Dr. Jeffrey L. Ecker, referring to a planned VBAC attempt.

Ecker, who directs maternal-fetal medicine at Massachusetts General Hospital in Boston, co-wrote the new guidelines, published in the journal Obstetrics

Even women who've had two prior cesareans might be good candidates for vaginal birth, he said.

He added that he hoped the new recommendations would help reduce the concerns about medical liability that many doctors have held out as a reason for not offering VBAC.

Today, about nine in 10 pregnant women in the U.S. end up with a repeat cesarean if they've already had one. By comparison about a third of all women who give birth have cesareans.

"I really think the cesarean rates are going up too fast," said Dr. Peter Bernstein, of the Albert Einstein College of Medicine in the Bronx, New York. "There is no good evidence that newborns are better off now than they were 20 years ago."

Bernstein, who is an ACOG fellow but did not work on the guidelines, said he was pleased with the new recommendations.

He said they updated information on what women would be good candidates for VBAC and were important in the discussion of delivery options that a woman should have with her doctor.

But he said it was hard to say if the guidelines would have any impact on the low VBAC rates.

Indeed, the guidelines note that health providers who feel uncomfortable with the delivery choice a woman has made may want to refer her to another provider.

-- Frederik Joelving

Friday, February 11, 2011

Anna's Birth Story

Prince T
February 2003

My first baby was in a breech presentation. "Your water bag has burst for more than 24hrs, leaving little fluid for baby to turn." my doctor told me. I was advised to have a Caesarean section.

Prince J
Mar 2005

For the birth of my 2nd son, I wanted to have a VBAC. I read up, did my research, planned, consulted, and did my exercises. My gynae was supposedly supportive, but on hindsight, I realised a lot of things went in the way of a Caesarean section. I went into labour spontaneously and laboured for more than 24 hours, but was still not fully dilated. It was then that my gynae suggested a Caesarean section due to "Failure to Progress".

I was very upset at the turn of events. I was not sure if I even wanted another baby because of the kind of birth process I had gone through. Family and friends reminded me to focus on the bundles of joy that I have, and not on the process. Over time, I got over it, but never forgot how it felt to have things out of control and totally the way I didn't like it to be.

When I finally felt ready to have another child, I was very determined that it not be a scary experience, but a joyful one. I engaged a doula, and prepared for it even more than for my second child. I also decided to switch to a doctor that was fully supportive of a VBA2C (Vaginal Birth After 2 Caesareans).

Princess E
Feb 2010
Successful VBA2C (Vaginal Birth After 2 Caesareans)
Natural birth, drug-free


It was the most amazing experience. Much more relaxing this time round as I laboured mostly at home. I got to the hospital at 1.45pm, and in less than 2 hours, Princess E was born at 3.21pm. Even my hubby felt like crying tears of joy. He keeps saying he wants more kids now, because of how joyful he felt, and how wonderful the birth experience was. But we are stopping at three, as they are already quite a handful!

- Anna

Thursday, February 10, 2011

VBA2C Mom Writes In

Thanks to the publicity of this blog on the Straits Times feature, a VBA2C mom writes me. Having a VBAC is already courageous. This mom had a natural birth early 2010 after two Caesarean sections! Will post her story here soon.

Wednesday, February 9, 2011

VBAC Feature in Straits Times

Today, Strait Times features an article about VBAC in the Mind Your Body section. It is pretty informative, highlighting the common view of most gynaes in Singapore and shares some current findings on the safety of VBACs.