Fear of litigation, combined with conflicting interpretations of the different risk factors, can sometimes turn practitioners and patients against each other, Alexander said.
Porchia said she has personally dealt with many women being pressured into C-sections. She said that after her years working as a doula, she thought there was very little chance of being able to go through with a VBAC in a hospital.
Press three, and the message will ask whether the caller is currently in labor. Alexander said she fields many of the calls herself, and has talked through hospital situations with countless women.
ACOG issued guidelines in stating that pregnant women have the right to refuse treatment, including a C-section. Support Provided By: Learn more. Thursday, Nov The Latest. World Agents for Change. Health Long-Term Care. For Teachers. NewsHour Shop. About Feedback Funders Support Jobs. Close Menu.
Email Address Subscribe. What do you think? Leave a respectful comment. Close Comment Window. Denise Jaimes-Villanueva was in active labor with her second child when she found out she was suddenly without a care provider. Jaimes-Villanueva was attempting a vaginal birth after cesarean VBAC , but her doctor, one she'd found after months of research—and who'd gone above and beyond to almost guarantee he'd be there, since he knew how hard it was for her to find a VBAC-supportive doctor—was unexpectedly busy, working at a hospital that prohibited the option.
Six centimeters dilated and breathing through contractions, she was faced with three options: Drive more than two hours in unpredictable southern California traffic to UCLA Medical Center where she had a chance of a vaginal birth , go to the closest hospital and accept a C-section she didn't want, or head into that same nearby hospital and decline a cesarean , laboring against hospital advice. Jaimes-Villanueva, then 38, had found her doctor after months of stressful and frustrating research.
He was one of the only doctors in her area who would consider accepting her as a VBAC patient. Almost every other obstetrician she'd talked to had cited prohibitive hospital rules or personal policies against it.
At the end of her pregnancy, this doctor was her last and best hope for the birth she wanted. Almost since the moment of her positive pregnancy test, Jaimes-Villanueva had been weighing options: calling doctors and hospitals, doing research, and considering a range of care providers and birthing scenarios.
One thing stayed constant throughout—she knew she wanted to attempt VBAC instead of a repeat cesarean. Women want VBAC for varied reasons, both deeply personal and purely medical: a previous traumatic birth, an aversion to surgery, a desire for an easier recovery especially while caring for older children.
Hospitals refuse it for an array of reasons, from the legitimate, patient-focused concerns wanting to reduce the risk of uterine rupture to the more convenient, doctor-driven causes it's undoubtedly easier for a doctor to schedule a C-section than to wait for a patient's labor to progress.
But shouldn't a woman who is informed about the risks and benefits of each type of birth—repeat cesarean or VBAC—be able to make her own decision? Now, in vast swathes of the United States, it can be difficult to find a nearby hospital or hospital-based provider much less your preferred nearby hospital or doctor who will support a woman attempting a VBAC, despite research showing that about 75 percent of people who attempt VBAC will be successful and not need an emergency C-section.
And in , obstetrician and researcher Dr. There's been mass media saturation on the "cesarean epidemic" in the U. In a survey, nearly half of American women who wanted to plan a VBAC reported that they did not have that option. As a result, the rate of vaginal births for women who've had a C-section in the United States last year was extremely low when compared to other developed countries :.
Uterine rupture, when there is a full tear in the uterus, usually at the site of a previous C-section incision, is the primary concern about VBAC. It is an obstetrical emergency requiring an immediate cesarean birth. But the practice guidelines evolved, and the low transverse incision became more common, really picking up steam in the s. By , the VBAC rate was at 28 percent, an all-time high.
Yet the VBACs that were happening were not always taking place under ideal conditions, with doctors neglecting to properly screen candidates or using cervical ripening to induce labor, which doctors now know increases the risk of uterine rupture.
It is a rough guideline, not a mandatory exercise. It seemed like these things might reverse the trend a bit, but they haven't. VBAC rates in the U. It's because some hospitals or doctors tell patients they won't do them, or don't even tell patients it's an option in the first place. Or, in extremely rare cases like the case of Rinat Dray , a Staten Island mother whose doctor overruled her wish to labor naturally, doctors go against the patient's request for a VBAC and perform a C-section anyway.
There are risks to consider for both VBAC and repeat elective cesareans. In , research showed that uterine rupture happens in 0. Complications of rupture can include hemorrhage, hysterectomy, and brain damage to the baby, hence the need to act quickly.
The risk of rupture is real, says Eugene Declercq, Ph. But, he adds: "There's a higher relative risk, but it's still happening very rarely. Repeat cesareans, too, come with serious risks, particularly for someone planning a larger family and thus requiring more cesareans.
There's a higher chance of placental abnormalities like placenta accreta , a potentially life-threatening condition where the placenta grows through the uterine wall , blood loss, infection, and a higher risk of maternal mortality and morbidity. That's the slippery slope. But high C-section rates around the world and in the U.
Both options do come with some risks, and those risks vary depending on the woman and the specific pregnancy. The biggest concern is the possibility of uterine rupture, which happens when the scar along the uterus from a previous C-section rips open during a vaginal delivery.
A uterine rupture could kill you. The chance of a rupture happening is less than 1 percent, though that number goes up when certain factors are added to the equation. The most influential is labor induction. In fact, it doubles the likelihood to 2 percent, he says.
The American Congress of Obstetricians and Gynecologists says that some women who have had two C-sections may even be eligible for VBAC as long as they have this horizontal scar. If your prior C-section incision extended up vertically along the uterus—or both horizontally and vertically so the scar is shaped like a T—the risk of rupture is more dangerous.
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