Reproductive Health

Birthing Options Grow Scarce after C-Sections

Tuesday, November 15, 2011

In her doula work Hana Askren finds that women who want a vaginal birth after a Caesarean often cannot find a doctor or hospital to provide this kind of care.

(WOMENSENEWS)--"Choice" is an American catchword.

We are constantly making choices about how to lead our lives. We wage political and economic battles over what kinds of choices citizens should be allowed to make--from school vouchers to having an abortion--with the recognition that each choice entails conflict.

But one choice you don't hear so much about is that of certain maternity patients to choose their birthing method. That's because, in this case, little choice is left.

Mainly I work as a journalist. But in my sideline work as a doula, or nonmedical birth assistant, I come across many women desiring the security of hospital facilities "just in case" who can still attempt a natural birth with a hospital-based midwife or doctor.

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No similar choice exists for many who have had a Caesarean section and would like to try a vaginal delivery referred to as a VBAC, vaginal birth after C-section.

If such women are not comfortable with giving birth at home, they are often unable to find a doctor to agree to attempt a vaginal birth in a hospital. One woman I spoke to worked with seven care providers in her part of Maryland, never finding a doctor to support her, while another, in Brooklyn, transferred three times before she found a VBAC-friendly practice. At that point she was 32 weeks along.

During the last 10 to 15 years, many hospitals have banned VBAC and obstetricians have stopped offering it in favor of elective repeat Caesarean sections, mainly due to liability concerns.

VBAC Safety Studied

At the same time, recent studies from health authorities such as the National Institutes of Health and the Agency for Health Quality and Research have shown that VBAC can be safe, often safer for the mother than a repeat Caesarean. There is a fraction of a percent chance that labor contractions will cause the old scar to separate. Meanwhile, repeat Caesarean sections carry a comparable risk of hemorrhage, infection and other complications, increasing with each subsequent surgery.

Mothers seek VBACs because they want to have more children, to avoid the complications of major surgery, and, as a college classmate of mine Angela Martinez, says, "I just want to go through normal birth. I feel like I cheated the first time around."

Consider Martinez's choices as she searches for a care provider for her second child in her home state of New Mexico. Since her first baby was born via Caesarean section due to fetal distress, there are no lingering physical abnormalities preventing her from attempting a VBAC.

There is one midwife-run birth center within an hour's drive from her rural home, which is rare, as most U.S. birth centers have shut down. But she isn't sure if she is comfortable giving birth outside a hospital.

In her town, most obstetric practices told her that they only performed scheduled repeat Caesarean sections, but she found one that offered VBAC services.

That practice had certain restrictions: If she did not go into labor before her doctor's estimated due date, or if labor failed to progress at a brisk enough pace, she would agree to an immediate Caesarean, even if no emergency existed. She would be required to have an epidural catheter placed and at least one dose administered in order to test the efficacy of the placement. She asked for the practice's VBAC success rates but did not manage to obtain them. When she told one of the doctors she was interested in a natural birth, the doctor responded, "There's nothing natural about VBAC."

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