Day-dreaming about VBAC and informed consent 4
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.
