Birthing Beautiful Ideas

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.

After months and months of a persistent cough, my son, M, has finally been diagnosed with bronchial asthma.  And while I’m sad that he has to deal with this condition for the next few years (or at least I hope for only a few more years), I’m also happy that he at least has options for treating his cough.

What’s more, I’m also thrilled with the way his new pediatrician handled his treatment options.  In fact, my interaction with her had me day-dreaming about what her approach to informed consent would look like if it were mapped onto the ways that OB/GYNs (and even midwifes) tend to approach the option between VBAC and repeat cesarean.

But before I recount my day-dream, I should give you a picture of what my interaction with M’s pediatrician looked like:

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Dr. S: Based on what you’re telling me, it sounds like your son probably has bronchial asthma, or what some people call “cough asthma.”  *Explains a bit about what it is.*

Me: What sorts of treatments do you recommend?

Dr. S: There are generally two options: Singulair, a medication traditionally used to treat the symptoms of asthma, or Boswellia, an herbal medication that I have also recommended to many of my patients.  From my experience, both seem to treat bronchial asthma equally well.  That being said, there have been many parents who have told me that they have preferred Boswellia since it doesn’t seem to have the same sorts of negative side effects that Singulair does.

Me: What are some of those negative side effects?

Dr. S: Mainly, some parents report that their children experience significant mood changes while taking Singulair.  And this is one of the side effects associated with the drug.

Me: Oh, okay.

Dr. S: *Explains the dosage and administration of each drug, the risks/benefits of each drug, also addresses where we could safely purchase Boswellia.*  Do you have an idea about which treatment you would like to use?

Me: My gut reaction tells me Boswellia, but would it be alright if I went home and researched it first?

Dr. S: Of course!  I actually encourage that.  Why don’t you call me in a couple of days when you make your decision, and then we can talk about how we will proceed from there.

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And then I started dreaming of what a prenatal appointment would look like if a doctor or midwife were to take the same empowering, informed-consent-supporting attitude that my son’s pediatrician took to his asthma treatment.

Dr. OB/GYN: Congratulations on your pregnancy!  Since you had a cesarean for your last birth, have you thought about what you would like for this birth?

Pregnant mama: Do you mean VBAC or a repeat cesarean?

Dr. OB/GYN: Yes!  Both are relatively safe options, although each one carries particular risks and benefits.

Pregnant mama: Can you tell me a little more about that?

Dr. OB/GYN: Of course.  The main risk associated with VBAC is that the uterine scar will begin to separate during labor.  This risk of “uterine rupture” is very small–only .7% for all VBACs, and only .4% if your labor begins on its own. 

Pregnant mama: Uterine rupture sounds very serious.  What about repeat cesarean?

Dr. OB/GYN: You’re right, uterine rupture is serious, but it is only “catastrophic” in approximately .05% of all VBACs.  So the risk itself is very, very small.  We may monitor you a bit more carefully in the hospital, but we can also take steps to make sure that you can still be upright and mobile during your labor.  And repeat cesareans, although relatively safe, also have serious risks.  For instance, each subsequent cesarean increases your risk of serious placental complications, such as placenta previa and accreta.  In addition, a recent study has shown that babies born after VBAC have lower NICU admission rates and fewer respiratory problems than babies born via elective repeat cesarean.

Now, this isn’t meant to scare you!  But it’s always good to know that there are risks associated with both options.

Pregnant mama: Do I have to decide right now?

Dr. OB/GYN: Of course not!  I encourage you to take the next few weeks to do some research on VBAC and repeat cesarean, and then we can discuss your plans during your next appointment.  (Editorial note: In a super-ideal world, the OB/GYN would also give the mom a couple of pamphlets on cesarean section and VBAC from ICAN.  A girl can dream, can’t she?)

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But I know from experience that these sorts of prenatal appoinments often look a little bit more like this.

Dr. OB/GYN: Congratulations on your pregnancy!  So, when are we going to schedule your repeat cesarean?

Pregnant mama: Well, what about VBAC?

Dr. OB/GYN: VBAC?!?!?!  Why would you ever want to do a thing like that?!?!?!  I.  DON’T.  DO.  VBACs.