Tuesday, October 23, 2012

The VBAC conversation I keep replaying over and over in my head


I don't have time to write this. This is stupid. I have tons more coursework to complete before my Birth Boot Camp certification in 15 days, and if I was going to write this post I should put a lot more time putting together statistics and studies, but I can't concentrate until I put this out here.

Last Saturday I received the text I have praying for: my friend is in labor. I've needed one more birth to observe before my BBC certification and her's was my last hope! She labored at home, we met at Salinas Valley Memorial Hospital, I got there and she was already pushing. Her sixth baby and first natural delivery. She did amazingly.

I was also thrilled with the attending OB, my OB during my first pregnancy and still the doctor I choose to see for all gynecological appointments, Dr. Gilbert. He didn't deliver Milo, but I've heard such wonderful things about him in the delivery room and I was glad to finally have the opportunity to see him work. I wasn't disappointed, he taught through much of the birth, pointing out the baby's unusual cord, the hand delivering up by her little neck, and the aspects of the placenta. I love his personality, but then another of those moments happened that reminded me while I don't deliver with this practice or that hospital.

A comment was made about me heading up to Santa Cruz for my birth, I mentioned that I actually think I will be going to Natividad.

"Just so you know, they say you can have a VBAC, then there tends to be some reason why you can't."

"I'm not having a VBAC (he seems to always forget that I delivered a 10lb baby vaginally, as if it cannot be done), but a 40% VBAC rate is better than 0%."

Cue the uterine rupture story.

I'm curious how many local women have heard this story, Gilbert has told it to me at least twice now. It's extremely sad, I don't want anyone to think I'm trying to lessen this incredibly tragic event. An OB from CHOMP was attending his daughter's VBAC in the bay area. Her uterus ruptured, she was rushed to surgery, the baby died. This has happened once at SVMH as well.

No disrespect is meant to the families who experienced loss in these scenarios, but this is like reminding someone about 9/11 when they are getting on a plane... these events are incredibly rare.

"The risk of rupture during a VBAC is less than 1% (actually 0.47%)"

"It may seem rare, but 1 in 100 babies is too much, all those babies add up."

I didn't want to start a debate in the delivery room while a mom bonds with her new baby, but I was stunned, and so upset, all at once. Did he really believe VBAC was that dangerous, or did he feel obligated to support the hospital's policy of not allowing VBAC (as nurses listen in) by playing up the risks and playing down... the truth? One in a 100 babies? Who has reported those kinds of perinatal mortality (death of a baby around birth) rates?

The perinatal mortality rate for VBAC is reported to be 3 out of 10,000. (The Thinking Woman's Guide to a Better Birth by Henci Goer)

The risk of infant death after a repeat, planned cesarean just like they do every single day at Salinas Valley Memorial Hospital and Community Hospital of the Monterey Peninsula, is 3 out of 10,000.

I've found less conservative estimates too:
"The risk of neonatal death from cesarean section was found to be nearly three times higher than from vaginal delivery." Marian F. MacDorman, Eugene Declerq, et al., Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with “No Indicated Risk,” 33 Birth 175 (2006). 
The way it was being presented, there was no risk to cesarean, and this is not the first time cesarean has been presented to me in this light from an obstetrician at Healthcare for Women. Not even the third time. I wonder what mothers needing accurate, unbiased information are getting? Not only do routine planned repeat cesareans not protect the baby, they put the mother in considerably more risk of death:
"The risk of maternal death from cesarean section is higher than for vaginal birth (in one study, four times higher), the rate of maternal complications is significantly higher with c-sections, and long term risks must be considered." Zelop & Heffner, The Downside of Cesarean delivery: Short- and Long-Term Complications Clinical Obstetrics and Gynecology, Vol 47, No. 2, June 2004, pp. 386-393.   
"The risks of severe maternal morbidity associated with planned cesarean delivery are  higher than those associated with planned vaginal delivery." Shiliang Liu, Robert M. Liston, et al., Maternal Mortality and Severe Morbidity Associated with LowRisk Planned Cesarean Delivery Versus Planned Vaginal Delivery at Term, Canadian Medical
Association. Journal. Ottawa: Feb 13, 2007. Vol. 176, Iss. 4; pg. 455.
A meta-analysis cited in Optimal Care in Childbirth by Henci Goer that included 380,000 women, at term, showed that 9 more women out of 100,000 died by opting for the planned repeat cesarean. A very large study showed that 21 more women out of 100,000 died. Not 21 out of 100,000... 21 MORE women died.

These are repeat cesareans, that means the mothers die leaving behind other children.  The complications associated with cesarean are so incredibly real yet are so consistently ignored. I'm so confused by educated, intelligent people who deny and downplay them, people that I like, that I want to recommend.

Truth be told, the nursing staff at SVMH were wonderful during and after the birth. The OB delivering did a fantastic job... but nothing went wrong that would require the mother to trust the judgement of the staff or her doctor, that's when having the best care counts. Considering that this practice and this hospital are not basing their VBAC policies on what is safest for women or babies, I'd be afraid to be in their care, even if I'm birthing with an unscarred uterus. They are either ignoring or not informing themselves in the science, studies, statistics, facts... of repeat cesareans; what else are they ignoring or have outdated information in? That makes me scared. It frustrates me that this information is there, the stories of hundreds of thousands of women... but they keep passing this one horror story on to women turning to their doctor for information they need to make a truly informed decision not just about their birth experience, their health, their future fertility, but about their LIFE, and their baby's life.

This keeps me up at night. I've considered writing letters, passing along books and studies... maybe when I'm done writing papers and working through this pile books and studies I'm required to read I will. There's just a slight nagging "I'm just one person, I'm not a doctor, I'm just a (perhaps overzealous) student, what will people think of me?" in my head.

Back to work.

1 comment:

  1. "UNLESS someone like you cares a whole awful lot, nothing is going to get better. It's not."
    Thanks for caring so much! Now go back to reading your pile of books :)

    ReplyDelete