Viewing entries in
Birth in the News
| Hospital | Primary Cesarean | Repeat Cesarean | Total Cesarean | ||||
| CPMC | 20.6% | 10.3% | 30.9% | ||||
| Kaiser | 24.2% | 7.5% | 31.7% | ||||
| SF General Hospital | 11.8% | 8.8% | 20.6% | ||||
| St. Lukes | 11.5% | 9.0% | 20.5% | ||||
| UCSF | 18.8% | 8.2% | 27% |
| Hospital | Forceps | Vacuum | Spontaneous | ||||
| CPMC | 1.8% | 7.6% | 58.5% | ||||
| Kaiser | 0 | 2.7% | 64.7 | ||||
| SF General Hospital | 1.1% | 4.6% | 72.8% | ||||
| St. Lukes | .4% | 3.4% | 75.7% | ||||
| UCSF | 4.3% | 3.1% | 64% |
| Hospital | VBAC | ||||||
| CPMC | 1.3% | ||||||
| Kaiser | .9% | ||||||
| SF General Hospital | 1.9% | ||||||
| St. Lukes | .1% | ||||||
| UCSF | 1.7 |
Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real--and can be fatal to both mom and baby--but rupture occurs in just 0.7% of cases. That's not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.
After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall--even though 73% of women who go this route successfully deliver without needing an emergency cesarean.
So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.
Continue reading here.
It would seem perfectly natural that a woman could give birth naturally if she wants to. Guess what? She can't.
An increasing number of hospitals in this country are refusing to offer women the option of delivering the way nature intended, if she had a cesarean section the first time around (and guess what -- chances are she hasI wrote an article in this week's issue of Time magazine called "The Trouble With Repeat Cesareans" on the subject of women's diminishing patient's rights. I won't repeat the story here, since you can link to it here, but will give some of the back story for those who want more:
This was a story I've been wanting to write for a long time. The short version is, doctors and hospitals are no longer allowing many women to have a vaginal birth after cesarean (or VBAC, pronounced "vee-back") because the "medicolegal" costs are too high. Or, as one ob-gyn put it when I asked why she and other doctors no longer allow VBACs, ""It's a numbers thing. It is financially unsustainable for doctors, hospitals and insurers to engage in a practice when the cost of doing business way exceeds the payback. You don't get sued for doing a C-section; you get sued for not doing a C-section."
Now, I think most of us realize that many hospitals are for-profit institutions and that doctors need to make money too, increasingly hard in this era of managed care. It is nonetheless tough to hear a physician talk about medical care in such bare-bones financial terms. So, um, we can't get the most appropriate care because it costs too much? What's especially galling is that VBACs are actually a much less expensive "procedure" (if childbirth can be termed that way) than cesarean sections, which are major abdominal surgery and require days more in the hospital. The costs the doctor is referring to are the malpractice insurance costs passed on to doctors. And those costs aren't even reasonable, but are largely in response to a few high-profile cases of VBACs gone awry dating back 10 years, many of which involved a labor-induction drug called Cytotec, which is no longer used during vaginal births after cesarean.
Meanwhile, according to the International Cesarean Awareness Network (ICAN), out of 2,849 hospitals with labor and delivery wards nationwide, 28% have total outright bans on VBAC and an additional 21% have de facto bans in that they say they'll do it but none of the doctors on staff will do it. That's half of American hospitals, but the numbers are probably much worse. Many of the rest will allow what's often termed "Cinderella VBACs" (a term coined by Henci Goer ) -- "yes, you can have a VBAC as long as you have it Monday - Friday, between 8 am and 5pm and you aren't over 40 weeks and we don't think your baby is too big".
Moreover, even if the hospital allows VBACs, it doesn't mean that all the doctors there are willing or eager to perform them. Take my own case. After I had a cesarean with my first child, I made a point to find a new practice that was VBAC-friendly. (I would have stayed with my first doctor, but my insurance switched, a whole other story). The practice I eventually signed up was very encouraging, telling me that VBACS had a 60-80% success rate and that their particular practiced boasted a 75% success rate. All good. Right?
Except, when I hit the 6 month point, my doctor said to me casually, "OK, let's schedule your C-section now."
"Excuse me?"
"Oh," he said, "You know, you only have a 13% chance of success with your VBAC." He went on to explain that since I had reached the "pushing" phase of my first labor, my chances of a successful VBAC were dismally low and therefore it made no sense to attempt one.
Furious at the bait-and-switch (doctors love, love, love C-sections -- in and out in an hour! No messy labor! No pesky doulas or family members hanging around!), I asked him to produce the study that said so. It turns out that the study, which dated back to 1999, was contradicted by several later studies, all of which showed a significantly higher rate of success -- between 40-60%. One study showed no difference in success rates at all, no matter where the first labor ran into trouble.
The doctor on call when I ended up giving birth on Thanksgiving weekend, was, needless to say, very much put out by my inconveniencing him. His revenge? He refused to talk to me while I was in labor, and didn't answer his pager when I was ready to push. So that's an example of a hospital that allows VBAC and supposedly pro-VBAC doctors for you. The truth is, doctors who are truly VBAC-friendly are few and far between. The good news is, I gave birth, via VBAC, to a perfectly healthy little boy and had a much quicker, easier recovery than I did with my C-section (which was hell, but another story).
I'll end with this story, much more dramatic than mine: After giving birth to her first child via cesarean, Alexandra Orchard, a CPA in Colorado Springs, was told her second baby measured too large to be delivered vaginally. "My doctor said, 'You're not only risking her life, you're going to break her collarbone when you push her out,'" Orchard recalls. Through tears, she scheduled a second cesarean. "I was in so much pain after each surgery that I don't even remember when I met my children." With her third child, Orchard was determined to get a VBAC, but her doctor refused. Orchard researched the risks and with the help of a midwife, labored for 30 hours and gave birth at home to a daughter, now almost two years old. Orchard is apprenticing to become a midwife because, she says, "I don't want my daughter to have to fight like I did."The Eastern woman's mind is such that many are completely satisfied with being Mothers. It's as if in the West we forget to valorize "love." What did we do today? "We 'loved', nourished and directed our children." From inside you can see what an accomplishment that really is. To love is to be near what is "real" in our life experience. Western minds want to see a materialization of what has been done but if we watch from our heart we can see that loving has been done but gone unattached and returned to the source: the infinite. Om.
-Letter to Nan, (author) April 4, 1983 from Radha Malasquez, Varanasi, India