VBAC Community ARTICLES

Vaginal Birth After Cesarean: The basics.

DEFINITIONS

VBAC: Vaginal Birth After Cesarean.

HBAC: Home Birth After Cesarean.
           
Cesarean or c-section: “The delivery of a fetus (baby) by surgical incision through the abdominal wall and uterus.” The name cesarean is “from the belief that Julius Caesar was born that way” http://wordnetweb.princeton.edu/perl/webwn?s=cesarean%20section

A cesarean is “usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request” for an otherwise natural birth. According to the World Health Organization, 5%-15% is the target C-section rate for any country. “In 2006, the rate of U.S. births by C-section was 31.1% -Rubin, Rita “ http://www.usatoday.com/news/health/2008-01-07-csections_N.htm

Elective Cesarean:  A cesarean performed at the mother’s request.

Emergency Cesarean:  A cesarean performed because the mother or child is in distress.

Trial of Labor: The term doctors use when a mother attempts to have a vaginal birth after having a c-section.

In my personal experience, I found the term “trial of labor” carries an underlying belief that a cesarean is more probable than a vaginal birth. As though I don’t get to have an actual labor, I only get to have a ‘trial labor’.  It is important to remember that “VBAC success rates are 60-80%.” http://www.womenshealthchannel.com/vbac/index.shtml.

The midwife who guided me through my successful VBAC did not like to use this term either – if I happen to mention it she would interrupt and say, no, no, it won’t be a trial, it will definitely be the real thing.

Doula:  “An assistant who provides various forms of non-medical support (physical, emotional and informed choice) in the childbirth process.” http://en.wikipedia.org/wiki/Doula

A doula’s medical training can be minimal or extensive. It is important to discover what specific medial training and practical experience a doula has before hiring one. 

Midwife: “A common name giving to a woman skilled in delivering babies.” (http://wordnetweb.princeton.edu/perl/webwn?s=midwife)

What Kind of Training Does a Midwife Have?
According to http://kidshealth.org/parent/pregnancy_newborn/pregnancy/midwives.html , midwives can be
certified nurse-midwives (CNMs)
certified midwife (CM)
certified professional midwife (CPM)
or a lay or direct-entry midwife.

“The subtitle a midwife uses will indicate the level of education and training. Most American midwives are certified nurse-midwives (CNMs) who:

• have at least a bachelor's degree and may have a master's or doctoral degree
• have completed both nursing and midwifery training
• have passed national and state licensing exams to become certified
• are licensed in every state
• may work in conjunction with doctors

About 96% of births assisted by certified nurse-midwives occur in hospitals.
A certified midwife (CM) is not a registered nurse but otherwise meets the same qualifications as a certified nurse-midwife. Because this certification has only existed since 1996, there are few CMs. Currently, only some states recognize this certification as sufficient for licensing.

A lay or direct-entry midwife may or may not have a college degree or a certification. Direct-entry midwives may have trained through apprenticeship, workshops, formal instruction, or a combination of these. Not all states require them to work in conjunction with doctors, and they usually practice in homes or non-hospital birth centers. But not every state regulates direct-entry midwives or allows them to practice.

A certified professional midwife (CPM) is certified by the North American Registry of Midwives after passing written exams and hands-on skill evaluations. Direct-entry midwives and certified nurse-midwives can apply for this certification. They're required to have out-of-hospital birth experience, and usually practice in homes and birth centers. Their legal status varies according to state.”
http://kidshealth.org/parent/pregnancy_newborn/pregnancy/midwives.html

Incision:  Cutting into the body or organ of a person

Uterine Rupture: When the scar from a previous c-section tears apart.  Rare, but potentially dangerous

What are the risks of a uterine rupture?
According to the Ask Dr Sears website:
“Nowadays, most cesarean incisions are made horizontally, in the lower part of the uterus (even in emergencies). This cut, a low-transverse incision or "bikini cut," is unlikely to rupture. With a low- transverse incision, authorities now estimate the risk of uterine rupture in subsequent labors to be around 0.2 percent, which means there is a 99.8 percent chance of mother going through a labor without rupturing her uterus. In a survey of 36,000 women attempting VBAC (vaginal birth after cesarean, pronounced Vee-back), no mother has died of uterine rupture, regardless of the type of prior uterine incision. In a study of 17,000 women attempting VBAC, no infants died as a result of uterine rupture. (Don't let the term rupture scare you -- it does not mean that your uterus will suddenly explode. Instead, the first cesarean scar gradually pulls apart. Fortunately, uterine rupture can be suspected by electronic fetal monitoring.) So the numbers are greatly in your favor -- having a VBAC is of negligible risk to you and your baby and certainly less risky than a surgical birth.” Ask Dr. Sears  http://www.askdrsears.com/html/1/T012300.asp

Ask Dr. Sears goes on to report that VBAC success rates, “for normal low-risk pregnancies, it should be at least 70 percent. Shun practitioners and hospitals that try to label you (as a VBAC candidate) "high risk" even if you have no risk factors besides a previous section. Studies show that even mothers with two or three previous cesarean births have a 70 percent success rate with VBAC if they deliver in a birthplace supportive of VBAC's. Obstetrical centers that specialize in VBAC's do not consider most VBAC candidates as high risk, and treat them no differently than any other obstetrical client. In fact, they consider it counterproductive to attach the "high risk" label to VBAC mothers. Most women wishing a VBAC should be treated like any other woman delivering a baby. They require no more or less technology, intervention, or monitoring. Beware especially of birth attendants who have a "pelvic prejudice" against small-hipped mothers wanting a VBAC. Many petite women have successfully pushed out big babies” Ask Dr. Sears  http://www.askdrsears.com/html/1/T012300.asp

What does this mean for you?
Be sure to ask your health care provider what their VBAC success rate is. If it’s lower than 60% you might want to investigate other health care practitioners.

If you have a midwife, what level of certification has she achieved and how many babies has she delivered? How many VBAC’s has she delivered? How many natural births? How many of her births have been c-sections?
Does your health care provider believe you can have a successful VBAC? Does he/she commonly use terms like “during your Trial of Labor” or does he/she phrase things in a more positive, successful way such as “during your labor.” These subtle differences set the stage for your entire birthing process.

For more information:

http://www.mothering.com/articles/pregnancy_birth/cesarean_vbac/sorry-state.html
http://www.consumerjusticegroup.com/birthinjury/vbac.html#resources
http://www.homebirth.org.uk/vbchances.htm
http://www.homebirth.co.uk

more definitions: http://www.insidehomebirth.com/glossary.html

More information about VBAC's

The Basics:

This pamphlet, from the american college of obstetricians and gynecologists, contains basic information about vaginal birth after cesarean delivery (VBAC): The American College of Obstetrictians and Gynecologist VBAC pamphlet

Emergency Cesareans?
A look at types of cesareans and the common medical reasons why women may have a cesarean today. http://pregnancychildbirth.suite101.com/

C-sections linked to epidural use:
http://www.childbirth.org/

This article provides a huge list of studies relating to various aspects of a VBAC. It gives authors/dates & a brief summation of the article.
VBAC scientific journal bibliography for years 2005+

This article summarizes data world wide relating to the risks of VBACs:
"Overall, attempted vaginal birth for women with a single previous low transeverse cesarean section is associated with a lower risk of complications for both mother and baby than routine repeat cesarean section." read more at:
Best Evidence of Safety for VBAC from VBAC.com

Past Articles:
(archived on WordPress)

Posterior vs anterior birthing positions

I’ve enjoyed the experience of fully dilating and pushing both posterior and anterior positioned babies. My first child, Kai, was in the posterior position, meaning his spine was lined up with my spine. In this position, the back of his head pushes against my spine during labor. It was my first labor and it ended in a c-section (although i had fully dilated and had been pushing for hours.) My second child, Madison, was in the anterior position, so her spine was lined up with my belly and her face pushed against my spine during contractions. (She was delivered vaginally) Having labored both posterior and anterior, I’m in a good position to describe and compare them. read more...

An Emotional VBAC Journey

I was entirely confident that my first child would be delivered naturally. I’m young, I’m fit, I’m strong, I’m flexible, I eat healthy, I don’t smoke, I don’t drink and I think positively. Not only was this child going to be delivered naturally, but I expected it to go rather quickly and without any need for pain medication of any sort. 36 hours of labour, and 3 hours of pushing later I was hyperventilating, dehydrated and exhausted into the deepest core of my bones. read more...