NIH VBAC Day 2 Coverage

While the day was much shorter, I found it had a much more personal level of it as speaker Rita Rubin took on the stories of women around the country who have been victims of VBAC bans, lack of evidence based medicine surrounding VBAC, and women being forced to take matters into their own hands with out of hospital and sometimes unassisted births.
It certainly gave the speakers a much more personal feel and put names and faces to women struggling with this.

But I will get to that later in my post.

The day started with information on epidural anesthesia, as well as the lack of available anesthesiologists nationally to fill the need of the “immediate emergency care/delivery” guideline. I learned a lot about the national crisis surrounding available anesthesiologists.

1. Epidurals do not cause, or mask symptoms of a uterine rupture, if anything they allow for other options other than general anesthesia in the case of a rupture of need for emergent delivery.
2. When the speaker asked ACOG what they mean by immediate in their recommendation, their answer was “Immediate means immediate” kinda like banging your head against the wall?
3. Rural hospitals, and hospitals in rural areas have lower number of anesthesiologists, meaning lower access to an anesthesiologist in an emergent situation.
4. Currently in The United States, there are less than 30,000 current practicing anesthesiologists.
5. 55% of those anesthesiologists are over the age of 55 meaning they will be retiring in the next roughly 10 years.
6. There is an increase in Woman anesthesiologists, but women are more likely to work part time, or less likely to take on over night shifts, or shifts in Obstetric anesthesiology because of the schedule.
7. 4% of hospitals with in house anesthesiologists have 500 or more deliveries a year.

All in all, having in house anesthesia specifically, and only for Obstetrics, or VBAC is completely unrealistic. Not only that, but one thing that caught my attention of this speaker was the comment that “We need to remove lawyers and insurance companies from this choice” meaning the choice of VBAC vs. elective repeat cesarean delivery.
There was a suggestion at one point that VBAC only be “allowed” at hospitals that have at least 1500 births per year, but unfortunately like the 24 hour anesthesiologist coverage just for VBAC it is simply unrealistic. There are areas of our country that women have a 3 hour drive, or even longer to a hospital of that kind of caliber.
In the end, ACOG blames the OB’s, the OB’s blame the hospitals, the hospitals blame the women… and it is a giant blame game.
We need to stop playing the blame game, and we need to make this an available option for all women, while using the real evidence on its safety!

Moving on to some more things I learned…

1. Placental Abruption & Cord Prolapse are more common than Uterine Rupture.
2. Trial of Labor has much lower rate of perinatal death in women with previous cesareans as opposed to elective repeat cesarean deliveries.
3. In a study, 20% of OB/GYN’s say they reduced their exposure to lawsuits by no longer offering VBAC.
4. The risk of fetal death in a first time mother, is the same as, a mother VBAC’ing.

The last thing there shows a statistical analysis that shows us no difference between a mother VBAC’ing her second child, and a first time mother giving birth to her first child. The fetal death rates are the same. This shows one thing to me, and many others who were also live tweeting during this, women are not being truly informed about all of the risks and benefits of VBAC.  Women are not being given accurate, and real information.

There were several comments about women and their providers needing to be the ones making the decision regarding the mothers choice to VBAC or have an elective repeat cesarean, and some may not agree with me, but in my opinion it shouldn’t have to do with her provider at all. It should be the patients decision, period.

Another part of the survey that made me giggle was one of the reasons cited for women opting for elective cesareans instead of VBAC was to avoid the pain of labor which I have been through twice, also ending both times in a cesarean delivery. Avoid pain? Who are you trying to fool because cesareans certainly are not avoiding pain by any means!

More bits and pieces I learned :

1. 49% of ACOG Fellows in one survey said they do more cesarean sections for fear of litigation.
2. There is more and more clear evidence that women want VBAC but are being denied these services by providers, as well as hospitals.

Then came the discussion of woman’s stories, and what has taken place all over the country to women searching for VBAC as an option. Several ICAN women were quoted, as well as featured which I loved!
Gina also known as The Feminist Breeder was featured, and her struggle to have a VBAC.
Joy Szabo of Arizona who had to drive 350 miles, leave her husband and 3 children behind because of her hospitals choice to ban VBAC after she had already had a VBAC at this facility!  (Joy will be on my radio show tomorrow night at 10pmEST)
The number of women, and their stories were touching, and made the whole experience and conference real it made the panel members, and audience members realize these are real women we are talking about and essentially deciding the future of their childbearing.

In many cases, the question and answer sessions were my favorite part. Although there were a few audience members who continued to get up with their long winded comments sometimes going no where, or no relevance to VBAC at all. Which bothered me because there was a clear line of providers and activists who had short, to the point, and important comments and questions.

Couple comments from the question and answer session which stood out to me :

1. “No one should be brought to the OR against their will or without their consent”
2. “I feel like I am committing a crime when I take a knife to a woman I know has a high VBAC success rate” – VBAC supportive OB working in a hospital with a VBAC Ban

(I promise, I am starting to get to the end)

One of my issues was the discussion on ethics when it comes to VBAC and elective repeat cesarean deliveries. There is such a gray line that is being crossed continually in this country. Women who have Child Protective Services called on them for being a “difficult patient” and that is something we should not be seeing at all. Being a difficult patient, and being an informed consumer should not be something women fear having their children taken because of.
We should not be seeing women rolled into the OR with Sheriffs or court orders.
We should not be seeing women charged with Murder over a stillbirth when a cesarean is declined.
These are real stories!

One last thing that really got me also!
A panel member said something about protecting the rights of patients AND providers… well ya know what.. the rights of the providers are the ones being protected, by these bans, the defensive medicine, women are the MOST venerable ones involved, and that should not be it!

I could sit on my soapbox for hours, so I will stop there.
I hope that the NIH takes this chance to really form a informed and evidence based guidelines and recommendation for this.

We will see tomorrow when they release it at noon!

Click to add your comment

Comment Guidelines
We all come from different backgrounds, and hold different opinions and beliefs...

While I understand and respect that, I expect the same respect from my readers. This website is “mine” and like my home, I expect respect, and reserve the right to “kick out” anyone who doesn’t follow the rules, just like I would in my home!

1. Trolls will automatically be deleted and banned
2. If you feel the urge to be disrespectful, or start a fight... move along.
3. No name calling... PERIOD

Happy Commenting!

Name (required)

Mail (will not be published) (required)

Website

Twitter ID

Notify me of followup comments via e-mail