Trusted Information for Healthy Pregnancies
VBAC
Vaginal birth can be OK after multiple C-sections
Feb 18th
Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who've had only one prior C-section, a new study suggests.
Still, the American College of Obstetrics and Gynecology (ACOG) does not currently recommend vaginal delivery for women who have had three or more C-sections, as their risk of uterine rupture has generally been thought to be higher.
In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.
In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.
Based on past research, the expected rate of uterine rupture among women with one prior C-section would be less than 1 percent; a large 2004 study of U.S. women, for example, found a rate of 0.7 percent.
These latest findings suggest it would be "reasonable to reconsider" the current ACOG recommendations for women with three or more prior C-sections, according to lead researcher Dr. Alison G. Cahill of Washington University School of Medicine in St. Louis.
For their study, Cahill and her colleagues reviewed the records of 25,000 women at 17 U.S. hospitals who gave birth after having at least one prior C-section. The group included 860 women with at least three prior C-sections, 89 of whom attempted a vaginal delivery; the remaining 771 elected to have a repeat C-section.
There were no cases of uterine rupture in either group, the researchers found.
The 89 women who chose to try labor also had no instances of bladder or bowel injury, or lacerations of the uterine artery -- the other main complications the researchers assessed. That compared with just over 2 percent of the women who had a repeat C-section -- though that difference, the researchers say, is not significant in statistical terms.
When it came to successful delivery -- meaning the doctor did not have to switch to a C-section during labor -- the chances were similar regardless of the number of prior C-sections.
Just over 13,600 women with one or two prior C-sections elected to try vaginal delivery, with a success rate of about 75 percent. That rate was 80 percent among women with a history of three or more C-sections.
Cahill pointed out that all of the women in the study had had C-sections done with what is called a low transverse incision -- a horizontal cut across the lowest part of the uterus. These types of incisions have a lower risk of rupture compared with the "classical" high vertical incision, an up-and-down incision made higher on the uterus.
Another factor to consider in the decision to try vaginal delivery after cesarean, according to Cahill, is whether a woman has ever had a previous vaginal birth. Previous vaginal deliveries increase the chances of success with a post-cesarean attempt at vaginal birth.
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Why a Page woman traveled 350 miles to Valley to have baby
Feb 16th
In order to deliver her baby the way she wanted, a woman said she would have to come to the Valley, 350 miles away from her home in Page.
Joy Szabo has four boys. Her first delivery was vaginal, her second a cesarean, her third a vaginal birth after cesarean or VBAC.
For her fourth... "I knew from the beginning that I wanted to deliver him vaginally, I had already had a successful VBAC and my doctor was on board with that," said Joy.
She planned to deliver at Banner's Page Hospital, until she learned the hospital would no longer allow VBAC births.
Joy spoke with the CEO.
“She told me she didn’t see any reason why I shouldn’t be able to deliver vaginally, but it wasn’t going to happen there. I needed to find some place else,” said Joy.
At this time Joy was entering her last trimester. She checked into it and home birth wasn’t an option. It’s illegal for a midwife to allow a woman to VBAC at home.
She would have to come to the Valley for a VBAC birth, 350 miles away from her Page home. With a husband and three young boys it wasn’t an easy task.
She was doing all this to avoid the risks that come along with a c-section surgery, but VBACs carry their own dangers. The biggest is the possible rupture of the C-section scar on the uterus.
OBGYN Dr. Roger Seymann has seen it and no longer handles VBACs because of it.
“Observing the horrendous outcome of opening the abdomen, seeing a baby in the belly, knowing this baby has a risk of neurologic damage, if it has in fact survived at all,” said Dr. Seymann.
Banner Hospitals say they don’t allow VBACs at their rural locations because they can’t provide the 24/7 care needed in case of a rupture.
Joy ended up delivering at Banner Gateway with a doula and a doctor that would work with her wishes.
Her doctor was Dr. Christine Brass of Mesa.
“I just carefully choose with the patient themselves you know who is going to be the best candidate for proceeding with a vaginal birth after cesarean,” said Dr. Brass.
She says there are plenty of factors that go into that consideration. Dr. Brass says women who had a c-section the first time because the baby was too big for their birth canal probably aren’t good candidates. A woman who has done a VBAC before, like Joy, is a great candidate.
Joy says she couldn’t be more happy with the outcome.
“There is an emotional side to delivering your own baby and being able to see what’s happening and participating in the process that really is valuable,” said Joy.
The ACOG guidelines recommend that both obstetrician and anesthesiologist need to be immediately available for elective VBAC in order to meet patient safety standards for laboring mothers and their infants.
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Four amazing childbirth stories from 2009
Jan 5th
-Southwest Airlines is often recognized as kid-friendly, and last year the airline proved that they're even equipped to deliver a baby. In December, a woman gave birth on a flight en route to Salt Lake City. When the woman went into labor, the pilot diverted the flight to Denver but this baby wanted to make a grand entrance at 30,0000 feet and was born in the back of the plane with the help of a doctor and two nurses who happened to be onboard.
-Think childbirth in an airplane sounds exciting? How about delivering in a helicopter? Natasha Watahomigie lives in the remote Supai Village at the bottom of the Grand Canyon where the only way out on land is by horseback. In December she went into labor several days early and a chopper came to the rescue. Her baby popped out on the short flight to a hospital. Natasha isn't the only member of her family to be born in a helicopter. Her sister delivered in a helicopter on Christmas day over 11 years ago.
-A playwright unexpectedly starred in his own drama when he helped his wife deliver their baby girl in the back seat of a Manhattan taxi last fall, according to the NY Post. Addison Proctor, and his wife, Sally Schuiling, were in a cab speeding from their Upper West Side apartment to NYU Medical Center when the baby's head popped out. "I scooped her up and put her on my chest, and she was breathing right away," Schuiling told the Post.
-Milwaukee mom Annmarie Schulte already went through three cesarean sections, and she was determined to have her fourth child naturally, according to the Milwaukee Wisconsin Journal Sentinal. Some doctors told her it shouldn't be done. Vaginal births after two c-sections are considered risky because they can cause uterine rupture. But Schulte found two midwives who agreed to work with her and a hospital where she could deliver. Only Schulte never made it to the hospital. She and her husband were caught in rush-hour traffic after her contractions started and they got in the car. In the front passenger seat of a 1998 Toyota Corolla, Schulte delivered her baby herself--can you get more natural than that? Schulte named her baby Cecilia Freeway Schulte.
Do you have an unusual birth story?
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Toddler Helps Deliver Mom’s Baby
Nov 19th
Two-year-old Jeremiha Taylor can count to five, he's potty trained, oh, and he's a pro at delivering a baby. Seriously. On Friday, this little man was instrumental in the birth of his baby brother when his mom unexpectedly went into serious labor right on the living room sofa.
"I laid on the couch and he went and got a towel. He grabbed a towel on his own," mom Bobbye Favazza told The Commercial Appeal of Memphis. "It happened so fast. My water broke and the baby came two to three minutes later. I just pushed and he caught him."
When emergency personnel finally arrived Favazza was holding her baby, the cord still attached, and they waddled over to the front door to let them in. Ambulance workers cut the cord and transferred mom and baby to a local hospital, where they were discharged a short time later with no complications.
The birth of Favazza's fourth child, named Kamron Taylor, didn't go remotely as planned. She had a cesarean section scheduled for Dec. 6 — she delivered all her kids that way — and she did have some pains the night before Kamron's birth, but didn't think they were related to labor.
Instead, she woke up the morning of Friday the 13th and conducted family business as usual. But when her water broke just before 8:30 a.m. she knew she had little time to spare. She called her mother, who frantically called 911, and her 3-year-old panicked and sat on the couch and cried. Meanwhile, Jeremiha calmly sprang to action — and the rest is history.
"He's my little hero," Favazza declared. "It was like he knew what to do."
Perhaps she has an aspiring ob/gyn on her hands.
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