VBAC = Very Bad At Communicating?

VBAC = Very Bad At Communicating?

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We can call it “poor communication skills.”

We can refer to things like “misinformation” and “misrepresentation” and “misguided intentions.”

We can even call out some of ‘em for what they really are: “lies.”

Yes, when some women discuss vaginal birth after cesarean (or VBAC) with their health care providers, the information they receive can be mangled by everything from poor communication to outright falsehoods.

You can take a look at my own VBAC Scare Tactics series, where each post has been “inspired” by actual misguided scare tactics that women have encountered in their quest to find a health care provider to attend their child’s birth.

You can scour My OB Said WHAT?!? to find some (outrageous) instances of this misinformation.

You can search any number of VBAC-relevant message or support boards to find women reporting the false or exaggerated or misguided claims that their OB/GYNs or midwives have made about VBAC.

You can also ask nearly any woman who has ever attempted to find a VBAC-supportive care provider, and most of them will probably have some VBAC-related whoppers to share.

Want some examples?

There are loads of women (and their friends, relatives, and other loved ones) who think that or who have been told that “VBAC only has a 70% success rate, so why would you want to risk your baby’s health like that?”

The truth is that the “70% success rate” means that (approximately) 70% of VBAC attempts will end in vaginal birth and 30% will end in a cesarean section.  This does not mean that 30% will end in uterine rupture–only .7% of women attempting VBAC experience uterine rupture, and the majority of those ruptures are not catastrophic.  Making an informed decision regarding VBAC and repeat cesarean involves receiving accurate, non-misleading information about the difference between VBAC success rates and uterine rupture rates.

There are women who have been told (or who have engaged in conversations that have implied) that VBAC carries an exhorbitantly large risk and that repeat cesarean carries little to no risk.  VBAC consent forms are generally good at “mis-communicating” this information.

The truth is that neither VBAC nor repeat cesarean is without risk.  The main risk associated with VBAC is uterine rupture, which occurs in approximately .7% of VBACs.  Repeat cesarean, however, is associated with a number of risks, including incision-site infection, hemorrhage, bowel obstruction, and an increased risk of placenta previa, accreta, and percreta in future pregnancies for the mother; and iatrogenic prematurity, respiratory problems, and lacerations for the baby.  Preserving patient autonomy regarding VBAC and repeat cesarean involves ensuring that women know the risks associated with both VBAC and repeat cesarean before they enter the hospital, regardless of their birthing choice.

Women have been told that VBAC is very unsafe for babies and that VBAC is downright silly since it is only about a woman seeking out a certain “experience” at the expense of her baby’s health and safety.

The truth is that current research concludes that babies born after a VBAC have lower NICU admission rates and fewer respiratory problems than babies born via elective repeat cesarean. And the truth is that VBAC is never just about a woman seeking a certain “birthing experience” at the expense of her baby’s health and safety–there are many other reasons that women choose VBAC over repeat cesarean.  VBAC is a safe and healthy option for many women, and actively discouraging VBAC might very well compromise maternal and neonatal health and safety when one takes into consideration the benefits of vaginal birth for moms and babies and the risks that repeat cesarean(s) pose to a woman’s future reproductive health.

My thoughts in a nutshell?

I think that care provider-initiated misinformation about VBAC eats away at informed consent and patient autonomy and maternal and neonatal health.

And I think that in many cases, health care providers need to be counseled on their counseling when it comes to VBAC.

This why I’d like to take these thoughts to the NIH Consensus Development Conference on VBAC in March.  And I’d like YOUR stories to help me do so!

Have you been lied to about vaginal birth after cesarean?

Did you face “VBAC scare tactics” during your pregnancy (or pregnancies)?

Were you misinformed about the relative risks (and benefits) of VBAC and repeat cesarean?

PLEASE SHARE YOUR STORY HERE SO THAT YOUR VOICE CAN BE HEARD AT THE NIH CONFERENCE!!!

Because advocating for women’s birthing choices isn’t just about making sure that health care providers are doing the right things–it’s also about making sure that health care providers learn and say the right things.



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17 Comments

  1. Michelle Potter
    Michelle Potter02-07-2010

    The worst bit of misinformation I heard about VBAC was when I was looking for an OB for my fourth VBAC. (That is, I’d had one c-section, and then three vaginal births, and was looking to have my fifth baby vaginally, too.) One doctor told me over the phone that each successive VBAC is *more* dangerous, and a higher risk for uterine rupture, than the last. It was one of the most ridiculous things I’ve ever heard!

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-09-2010

      @Michelle – As I’m sure you know, the claim about subsequent VBACs having a higher risk of uterine rupture is absolutely untrue! In fact, some recent studies have shown the very OPPOSITE to be true. According to this study by Mercer et al, the VBAC success rate increases after EACH VBAC, and the risk of uterine rupture DECREASES after the first VBAC and does not increase thereafter.

    • Claudia
      Claudia08-29-2010

      I asked my OBGyn if I could have a Vbac. He had told since I had my son 2 yrs ago
      That I would have to do a repeat csection. I didn’t ask any questions. I thought it was the law. I spoke with a friend that is a nurse and got so mad at the misinformation I was given. It didn’t matter since I miscarried not long after that at 9 weeks. When I got pregnant again I asked about the Vbac this time more informed and he let an exhale out and said he recommended the csection

      • BirthingBeautifulIdeas
        BirthingBeautifulIdeas08-30-2010

        Claudia, I’m so sorry that you’ve run into such difficulty with your doctor! Have you considered changing care providers? It sounds like you really want a VBAC, and having a supportive care provider is key when it comes to planning a VBAC. It will probably make for a much less stressful pregnancy in the long run, too!

  2. Best of the Birth Blogs – Week Ending February 7th | ICAN Blog
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  3. My OB said WHAT?!?
    My OB said WHAT?!?02-08-2010

    Thanks for the shout out! We love your “definition” of VBAC! You stated it like it is!

  4. TheFeministBreeder
    TheFeministBreeder02-08-2010

    I can’t wait to see you at the NIH conference! I’m setting up a “VBACtivists Luncheon” and I’d love you to be there. Ohhh… the things we can go on about! http://www.facebook.com/home.php#!/event.php?eid=290022353654&index=1
    .-= TheFeministBreeder´s last blog ..You Guys are Making Me Cry =-.

  5. Lisl
    Lisl02-09-2010

    My favorite is the “bait and switch” – they start off positive (“oh yes, we support vbacs”), but as the pregnancy progresses gradually start injecting negative ideas (“don’t get TOO wedded to the idea of a vbac” and “the second section is SO much easier”). Finally, there’s the “better schedule the section so that you get it when you want it” talk (or better put, let me get you on the calendar in the morning so I can fit it in before office hours). In my case, there was no discussion about pros and cons of vbac vs. section, the practice neglected to inform me that my surgical report had not been provided by my former OB until well into the third trimester (even though I had made calls and signed various consent forms months prior) and then with no notice scheduled me for a section 2 weeks before my due date (I found out when the hospital called me to confirm), even though I had consistently discussed vbac, going into labour naturally and having an unmedicated birth throughout my prenatal visits. They probably thought that 34 weeks was too late for me to move … it wasn’t. I did manage to have a successful vbac at a different hospital with an incredibly supportive midwife (not to mention doula and husband).

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-09-2010

      @Lisl – Oh yes, the bait and switch. I’ve gotten that one myself!

      You’re right–there’s rarely any mention that each subsequent c-section carries a higher risk of placenta accreta and other major complications, but all sorts of fear-mongering about the very real yet VERY RARE risk of uterine rupture for a VBAC.

      Anyway, GOOD FOR YOU for switching at 34 weeks! I love hearing positive stories like that!

  6. Amy Romano
    Amy Romano02-22-2010

    I have *twice* had doctors tell me AFTER THE BABY WAS ALREADY OUT AND HEALTHY that a mother should have had a c-section. In both cases, the main issue was that labor was slow (failure to be patient), but the fetal heart tones were fine both times. And both mothers were of course thrilled to have avoided surgery. I have a hard enough time understanding why doctors (and others) are so single minded about repeat cesarean when they talk to a pregnant woman, but to look at a healthy, deliriously happy mother and a healthy, alert baby and say she should have had a c-section is downright ridiculous.
    .-= Amy Romano´s last blog ..Becoming a Critical Reader: Bias, Bias Everywhere! =-.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-23-2010

      @Amy Romano – Wow. Out of curiosity, did you ask those doctors what exactly a c-section would have prevented, ameliorated, or benefited in those cases? For the life of me, I can’t think of any rational or coherent response they could have given!

  7. Sara
    Sara02-23-2010

    I had an OB/GYN scream at me I was an “obstetrical disaster” and then threaten me with a “leaky bladder” if I attempted a VBAC.
    She also looked at my husband and said “Do you want a dead baby and dead wife?”
    At 39 wks 3days I was told “Have a repeat c-section or find another care provider!” The hospital staff told me the same thing and “it’s the only option!” So much for Patient’ Rights! lol
    All based on an ultrasound at 38wks that said my baby was 98%. My first son was 9lbs 1oz at birth, 40wks term. I’m 5’4” and 125lbs and was told I’m just “too small” to give birth.
    There is more to this story.
    I delivered my second son vaginally at another hospital May 11, 2009. Only 12 hours of labor, 1 hour or pushing, no edipural, tears, forceps, KIWI…etc.
    Ready for the shocker??? He weighed in at 9lb 1/2 oz!
    I just filed my grievance with the medical compliance officer on 2/22/10!

  8. Rachel
    Rachel02-24-2010

    I got the bait and switch, but thank goodness the “switch” happened at 16 weeks instead of 36 weeks. I had plenty of time to find a different provider and ended up with an amazing VBAC :)

    My first OB gave me a number of reasons for why he did not “do” VBACs. One of them was that apparently, according to a recent study published in the New England Journal of Medicine, women are not “satisfied” even if their VBAC is successful. This study supposedly found that women who had successful VBACs were unhappy with the experience and their recovery.

    Yes, that’s right, my OB – who clearly knew nothing about me – was telling me what would and would not SATISFY me. We left and never looked back.

  9. Glenda
    Glenda03-08-2010

    I tried to plan a VBAC at a ‘ban’ hospital as the alternative is a 2.5 hr. drive or a homebirth. I received a letter from the hospital that informed me they would not take me (I know my patient rights hold otherwise) and that more babies die from uterine rupture than they do for a repeat cesarean. Of course they didn’t mention anything of the risks to me or baby from the repeat cesarean such as maternal death, iatrogenic prematurity, etc. SO tired of docs and hospitals watching their own backs instead of taking care of women based on evidence! Fight hard for us!!!

  10. Kimberly pigott
    Kimberly pigott05-25-2011

    My story is crazy. I am currently seeking a vbac for the delivery of my son. My Ob/gym has told me that there is a 30%chance my uterus will rupture, that a women he knew had persued a vbac and her baby ended up aquadrapelegic from fetal distress. Which correct me iron wrong but an unborn children go into distress from pitosin causing too strong of contractions. I feel that doctors should support their patients decisions. Itscalled patient rights. They shouldn’t scare them into making a decision just because the doctor doesn’t agree with what they are wanting.

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