Anyone with info or expereicne with a VBA2C?

[BirthBuddy]

Hi ladies.

I have a mom who desperately wants a VBA2C. She is fit and healthy and in retrospect realises that she never needed a Caesarean in the first place.

With her first she laboured well and got all the way to 9cm (and fairly quickly) and was flat on her back and was told in transition that her labour was stalled and baby wouldn't fit through and she MUST have a Caesarean. Not knowing any better she went along with it....

With her second she already wanted a VBAC and found a doctor who agreed to it - not easy in SA. Unfortunately she travelled out of town at 38 week and went into labour and ended up going into the small local hospital in the town she was travelling through. Although she was labouring well and was at 5cm by then, they would not allow a VBAC and insisted that Caesarean be performed. She was not happy, but it went ahead anyway, as she felt she had no choice.

She is now pregnant a 3rd time (the other children are 2 & 4) and she desperately wants to birth vaginally this time. It's like a primal need she has (which I can understand) and at the very least she wants to have a trial of labour and at least be allowed to spontaneous go into labour, even if only for a short while. She is reading, researching and really educating herself well.

BUT she can not find a single OB/GYN in South Africa to support her. 2 midwives have told her they would be prepared to do it, in a hospital setting, but only if she finds a doctor to support her...

I have searched high and low for her and she has phoned many and visited a few doctors and she is turned away almost immediately and told there's no way and it's far too risky, and that no one will do it. Yet my research shows that a VBA2C is hardly more risky than a VBA1C and even that risk is pretty darn low. I have found many cases of successful VBACs, VBA2Cs, VBA3Cs, HVBACs, WVBACs, UVBACs, etc , you name it..

So why are doctors so anti- VBAC? Are they working off outdated info and not the latest evidence based research? How can we convince them to let this poor women have what is rightfully hers to have, a natural vaginal birth!!??

The saddest thing is that this poor woman who is more in need of support than normal, is being given far less, and is almost considering an unassisted birth as a consequence... Now chances are it would turn out fine, but I think that could be putting her and or her baby at risk if anything DID happen, whereas if they were in a hospital with compassionate and professional support she would be perfectly safe.

What can I do to help this lady get what she wants?

p.s. She is also considering lying about having 2 Caesareans at this stage, as SOME doctors will do a VBAC but just not a VBA2C... is this a good idea to try that? She is an attorney, so she doesn't feel comfortable knowingly lying. But she said she'd even draft a contract absolving the caregiver from liability - that's how much she wants this...

Any input or advice??

[doula Michele]

I have a very good friend who had a VBA3C.
It was a midwife homebirth too.
www.mother-care.ca she has tons of info on her website, and will chat with you if you need more info.

[BirthBuddy]

Thanks Michele,

My mama is actively seeking out people with experience to chat to, so can we maybe link them up via e-mail?

This poor woman wants this so bad and has said I am the only one she can open up to because everyone else thinks she is crazy and should just go ahead and have a Caesarean. She said her husband is supportive but even he doesn't really understand.

Now I have never had a Caesarean - but I always felt a strong urge to give birth (and be pregnant and to breastfeed etc) and after birthing I do consider my births to be my greatest life a achievements! So I can totally relate to her urge to want to do it... or at least be given a reasonable chance to TRY.

Ta
Jane

[doula Michele]

Quote:

Originally Posted by BirthBuddy Thanks Michele, My mama is actively seeking out people with experience to chat to, so can we maybe link them up via e-mail? This poor woman wants this so bad and has said I am the only one she can open up to because everyone else thinks she is crazy and should just go ahead and have a Caesarean. She said her husband is supportive but even he doesn't really understand. Now I have never had a Caesarean - but I always felt a strong urge to give birth (and be pregnant and to breastfeed etc) and after birthing I do consider my births to be my greatest life a achievements! So I can totally relate to her urge to want to do it... or at least be given a reasonable chance to TRY. Ta Jane

No problem... yes, contact Connie for sure, she has tons of info and is a great support! And she is a great friend or mine.
I know she is a board member of ICAN as awell.

[BirthBuddy]

Thanks again Michelle,

I have passed Connie's contact details on to my mama. She has travelled away today in a last ditch effort to find a doctor.

She is from South Africa, and am sure she'll mention that in her mail, so perhaps you could just give Connie a heads up as to where she has come from?

Thanks.

[doula Michele]

Quote:

Originally Posted by BirthBuddy Thanks again Michelle, I have passed Connie's contact details on to my mama. She has travelled away today in a last ditch effort to find a doctor. She is from South Africa, and am sure she'll mention that in her mail, so perhaps you could just give Connie a heads up as to where she has come from? Thanks.

You bet.. I will email Connie right away.
Good luck to your mama.

[joandchris18]

I really feel for this mama. I am preg with#3 and have also had 2 previous sections. I am like her, I want a vbac soooo bad, although I am able to do a homebirth with a midwife to hopefully make it happen, unlike her. I wish she had the same opportunities that I do. Yes the internet provides so much evidence that even after multiple sections, a trial of labor has less risks than a scheduled section does. Its amazing that there are birth professionals out there in the world who choose not to use that evidence-based care in their practice.

[rhythmsofgrace]

This may be an odd thought, but it might work...Does she HAVE to birth in South Africa? Would she be willing to have her baby in another country where she could find a doc that is more willing to support a VBA2C? Just a thought if worse comes to worse. I hope she is able to find a doc to help her!

[BirthBuddy]

She has considered travelling out of the country, but she does have 2 children here and both her parents are local so this is where her support is.

She just sent an update on her latest doctor visit, she has contacted at least 10 different doctors and has been to see a few...

Here's some of her message (no private info included)

"It was terrible and a total disaster cause it has now made my husband doubt the safety of a trial even more.

Apparently she is a good Doctor, but she had no tact and was quite rude in fact. I think when you deal with any client,,,rude is not the way to go...,maybe I am too nice to people.

I spoke to her and told her that I don't want another caesarian and her reply to me was ,,,, Well , then you should not have planned another pregnancy,,,,,,, and I was quite shocked,,, we just drove the whole morning ...300km's to see her,,, she was cocky and said midwives are reckless and will tell you they can help you and that she has stopped backing up midwives.

I then asked her if she then herself would allow me a trial and she said for a first vbac yes ,,,but not for a second...She would rather do 20 caesars, knowing that all are fine.

i respect her opinion and her safety facts,,,but she was rude ,insensitive and told me that I don't have to worry about the consultation....( I had no problem paying her at all,,she did consult with me) ... and threw the file on her receptionist desk ,,,telling her,,, cancell it ... a midwife patient..."

This is the kind of thing she is dealing with here... hence the unacceptably high Caesarean rate here. It's 60+%!!!!

ARGH!

My gynae, who is a fabulous man, has told me he has personally seen VBA2Cs due to rural women turning up at the government hospital too late for their second caesarean and pushing the baby out before they have a chance to get her into Theatre, so he knows it's possible. He unfortunately has specialised in fertility treatments now and doesn't do birth any more, even though he loved it - because the insurance is too high for the number of births he was performing. he said it's R100 000 per year!

However it seems to be the South African Medical Associations decree that VBA2Cs carry an unacceptable risk

This woman is even thinking of doing the latter and fibbing about her due date and just not going into hospital until she is in labour... would any of you advise this as a good idea...?

I have been careful to explain to her that I can not give her medical advice and much as I support her and understand her I can't tell her to do anything dangerous, but I will help her with whatever she chooses to do.

[bshumway]

This one is such a toughy!

I am sure that some day there will be more of thewse to tell about. The one VBA2C I attended did not work out. The medical community is making progress and I have access to one of the best VBAC OBGYN's in the area. I know she can tell some stories, I'll have to ask her.

[Lellens]

Hi Jane

I am also living in Cape Town and am pregnant with my 3rd child. My two daughters are 14 and 15 years old and both were born by C-Section, both I feel unnecessary. I am also adamant that I do not want another C-Section but my Gynae will not allow me to have a VBA2C. He says unless I go into labour at 34/35 weeks and the baby is almost falling out. So I am sure you can guess what I am praying for....

Have you had any luck finding out any info on doctors in South Africa who are willing to help in this situation?

VBA2C Hopeful...

Helen

[Lellens]

Oh and does anyone have any statistics and information on the risks of C-Section as opposed to VBA2C's?

Thanks

Helen

[BirthBuddy]

Hi Helen,

I just responded to your other post, and just saw this here on a post I recommended you read.

Anyway I have yet to find a gynae in Cape Town who WILL support a VBA2C unfortunately, although my gynae says he has seen it happen - in government hospitals where the woman doesn't come in for her 3rd Caesarean in time and ends up birthing vaginally 'by mistake' so he know it can and has been done. He said there is not enough medical evidence to support it being done routinely and sadly our Caesarean rate is so horrifically high here in SA, that it's most doc's preferred method of delivery anyway, never mind in a more complicated case...

You best bet is linking up with a private midwife - I can recommend a few to you, if you like - but even then you'll need a gynae to oversee your case.

I do believe that the more ladies demanding VBACs though and VBA2C the better and the more our doctors will be forced to start supporting them.

As far as I know the lady that 'got away with' a VBA2C recently, fudged her dates and agreed to a 40 week Caesarean but then went into labour and delivered a week or so before that, when she was actually full term already But you said your doc is aware of your dates..?

I hope we can find a way to help you.

All the best.
Jane

[BirthBuddy]

Here's info I have found from my previous research which may help:

I did some research quickly and here is what I found. (Of course the sites are from UK, USA and Australia - but the same should apply here in SA!)

Does two caesareans always mean a third? My last two babies were breech, if my third baby is the right way around can I give birth naturally?

No, two caesareans does not necessarily mean a third. Research has found that women attempting vaginal birth after two caesareans should be treated no differently than a woman who has had one previous caesarean. The key here will be finding a midwife or doctor who will support you in giving birth naturally. Some healthcare practitioners will be supportive while others will not.

from http://www.pregnancy.com.au/vaginal_..._caesarean.htm


'A Guide to Effective Care in Pregnancy and Childbirth', which is a well-respected summary of evidence-based practice, says:

"The available data show that among [women who have had more than one previous caesarean] the overall vaginal birth rate is little different from that seen in women who have had only one previous cesarean section. Successful trials of labor have been carried out on women who have had three or more previous caesarean sections."

"The rate of uterine dehiscence in women who have had more than one previous cesarean section is slightly higher than the dehiscence rate in women with only one previous cesarean, but dehiscences in the reported series tend to be asymptomatic and without serious sequelae. No data have been reported on other maternal or infant morbidity specifically associated with multiple previous cesarean sections."

"While the number of cases reported is still small, the available evidence does not suggest that a woman who has had more than one previous cesarean section should be treated any differently from the woman who has had only one cesarean section."

From: http://www.homebirth.org.uk/vba2c.htm

Is trying for a Vaginal Birth After Cesarean (VBAC) a reasonable option after you've had 2 (or more) cesarean sections?
Most authors conclude that it is, but many OBs are reluctant to consider it, especially recently due to a VBAC backlash movement. Because many doctors have been reluctant to consider it, most medical literature and collections of VBAC stories have concentrated on VBAC after 1 cesarean (VBA1C). There is an urgent need for information, analysis of medical literature, and stories of VBAC after multiple cesareans (VBA2+C).

From: http://www.plus-size-pregnancy.org/C...after_2_cs.htm

VBAC after two previous c/s is not so uncommon - there are several women on the HBAC list below who have done it, for example, and several studies showing that the majority of women attempting VBAC after two past c/s will be successful. For example, in this study the chance of a successful VBAC after 2 c/s was 70%:

Obstet Gynecol 1990 Nov;76(5 Pt 1):865-9
Vaginal birth after cesarean: a meta-analysis of indicators for success.
By Rosen MG, Dickinson JC

The new (August 2000) edition of 'A Guide to Effective Care in Preg & Childbirth' (ECPC) by Enkin, Keirse et al says a woman with two or more previous caesareans should be treated just like a woman with one previous caesarean when approaching VBAC.

From: http://www.radmid.demon.co.uk/vbac.htm#2

Who are candidates for a trial of labor?
Most patients who have had a low-transverse uterine incision from a previous cesarean delivery and who have no contraindications for vaginal birth are candidates for a trial of labor. Women who have had two previous low-transverse cesarean deliveries also may be considered for a trial of labor, but the risk of uterine rupture increases with the number of previous uterine incisions (2). Following are selection criteria useful in identifying candidates for VBAC:

* One or two prior low-transverse cesarean deliveries
* Clinically adequate pelvis
* No other uterine scars or previous rupture
* Physician immediately available throughout active labor capable of monitoring labor and performing an emergency cesarean delivery
* Availability of anesthesia and personnel for emergency cesarean delivery

From: http://www.medem.com/search/article_..._typ=NAV_SERCH

A retrospective study was conducted involving 308 patients with previous caesarean sections and current singleton pregnancy. All the women delivered at the University Teaching Hospital Zaria, after having been in established labour. The aim was to determine any significant maternal and fetal risk attributable to labour in patients with more than one previous caesarean which may mitigate against a trial of vaginal delivery. The study analysis involved a group of patients with one previous caesarean section compared with those with more than one (multiple) caesarean section who delivered vaginally or abdominally after having been in established labour. The results showed that there was no significant difference in maternal and perinatal mortality rates and perinatal morbidity rates between the two groups. The patients with multiple caesarean sections who failed to deliver vaginally had increased rates of postoperative pyrexia (18.7%), anaemia (23.4%) and blood transfusion (35.3%). The study showed that the risk of fatal outcome related to labour in patients with multiple caesarean sections was low and could be eliminated by careful patient selection and close intrapartum care. A positive review of policy towards a trial of vaginal delivery in multiple caesarean sections is therefore advocated in view of the advances in patient management in contemporary obstetric care. The gains in terms of patient compliance towards hospital care and supervised delivery will be considerable. A multicentre, prospective case-controlled trial will clearly define the risks attributable to this policy change.

From: http://www.ingentaconnect.com/content/tandf/cjog/1998/00000018/00000001/art00005


BACKGROUND: Caesarean section is carried out for the benefit of both mother and baby. Most obstetricians will permit vaginal birth after a previous caesarean. An unplanned vaginal birth after two previous caesareans section is reported. METHODS: A case report utilizing the case records and review of relevant literature. RESULT: A 32-year old housewife gravida3, para(2+0), both alive with two previous caesarean sections had a premature rupture of membranes and preterm labour. She had an unplanned successful vaginal birth. CONCLUSION: Vaginal delivery is possible after two previous caesarean sections if careful selection of patients is made.

from: http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract


So there's a lot of evidence to suggest that a VBA2C is perfectly possible and there's no reason not to attempt one especially if you are in good health.

I hope that will help.

[BirthBuddy]

And here's another article supporting Vaginal Birth a Safe Option After Multiple C-Sections

Quote:

Vaginal Birth a Safe Option After Multiple C-Sections Posted 9/12/2006 COLUMBUS, Ohio – Very few, if any, obstetric topics have raised more discussion and controversy in the past several years than VBAC, or vaginal birth after cesarean section. Most studies on this subject have come from small, single institutions or have relied on birth certificate data with all of its inherent inaccuracies. Mark Landon, M.D. In his most recent analysis of multicenter data collected over four years, Dr. Mark Landon evaluated the risk of complication and success of VBAC in women who had undergone more than one prior cesarean delivery. The 19-academic center study was led by Landon and conducted through the National Institutes of Health, Maternal Fetal Medicine Units Network. Its data included more than 45,000 patients with previous cesarean section, which included almost 18,000 women undergoing a trial of labor or an attempt at VBAC. "This was the first large study of VBAC in which certain outcomes, such as uterine rupture, were studied prospectively," notes Landon, who serves as vice chairman of obstetrics and gynecology at the Ohio State University Medical Center. Landon found that the risk of uterine rupture was 0.9 percent in cases of women with a history of multiple prior cesarean deliveries undergoing a trial of labor, compared with 0.7 percent in the cases of patients who had experienced only one previous cesarean delivery. These data challenge the notion that women with more than one prior cesarean are at dramatically increased risk for uterine rupture with a VBAC attempt. "We looked at the outcomes associated with uterine rupture, including catastrophic outcomes such as stillbirth, or hypoxic brain injury to the baby," says Landon. "And the good news is that the vast majority of uterine ruptures fortunately are associated with healthy infants. The absolute risk of catastrophic rupture with poor outcome is, in fact, quite small." Landon's study confirms that uterine rupture is the complication with the greatest risk attributable to trial of labor; however, it also shows the risk for uterine rupture is not significantly increased in women with multiple prior cesarean deliveries compared to a single prior operation. "The study has confirmed that the majority of women with multiple prior cesarean deliveries undergoing trial of labor can expect to achieve a successful vaginal birth," says Landon, whose findings were published recently in the journal Obstetrics and Gynecology. The benefits of VBAC include a faster recovery time and avoidance of the operative risks of cesarean section, which is a major operation. "Beyond these obvious benefits, there seems to be a component that is not completely tangible," notes Landon. "It goes along with the experience of vaginal childbirth, which certain women value, and there is probably not a price that you could put on that for a certain subgroup of women." Each case should be individualized, says Landon, in terms of the risks involved, the likelihood of success of VBAC, and the individual woman's desire to proceed with attempted vaginal delivery vs. cesarean section. "Future childbearing plans are important, since the risk of cesarean complications rises dramatically after three operations," according to Landon. Landon advises that women should carefully research the topic of VBAC, looking for a physician who is willing to share data in an unbiased manner, who supports the concept of VBAC provided that a woman is an appropriate candidate, and who is willing to evaluate each case individually. "About two-thirds of women who have had a previous cesarean delivery are actually candidates for VBAC," says Landon. "VBAC after multiple cesarean sections should remain an option for eligible women." The Ohio State University Medical Center has consistently been named one of America's best hospitals by U.S. News & World Report magazine with nine specialty programs being listed as among the country's best in the most recent edition. Also, 173 faculty members are included in the most recent edition of the nationally acclaimed directory, "Best Doctors in America." # # # Betsy Samuels Medical Center Communications 614.293.3737 betsy.samuels@osumc.edu

Can you tell that this is something I am passionate about?

The Caesarean section rate in SA is too high and women who do NOT want Caesareans MUST be heard...