OB’s Aren’t Listening to ACOG

OB’s aren’t listening to ACOG. While this is a huge shock for some people, it is not surprising for others. But how did I come to this conclusion? Well, becoming pregnant put me in a position I was not comfortable being in yet. Being a woman looking for a trial of labor after two previous cesarean sections. One that was not medically necessary at all, and one that saved my youngest son. While I believe if things had been done slightly differently the second could have been avoidable, but it was a catch 22.

In July of this year, ACOG released new VBAC recommendations in response to the growing cesarean rate, complications that are a direct result of that, the falling VBAC numbers, and the lack of access for VBAC that was all brought out in the National Health Institute’s VBAC Consensus back in March. I was lucky enough to be able to watch the entire conference from home, and take a ton of great information from it. But it also hit ACOG hard because their representatives knew that their guideline changes essentially caused the decline in VBAC access for women Nationally.

On July 21st, ACOG made a new press release detailing some of their new VBAC guidelines, which included a statement on women with two previous cesarean deliveries.

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, “The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC,” said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

Ok, so what is the big deal right? It says right there that ACOG supports and finds a trial of labor acceptable and essentially a safe option for women with two prior cesarean sections.

So what is the hang up? Apparently all the same OB/GYN’s out there that were quick to jump ship on VBAC when the guidelines changed years ago with new guidelines on the readiness of Anesthesia in the hospital, are NOT as quick to jump back ON the VBAC bus despite the clinical information showing it to be a safe choice.

Where does that leave me right now?

Screwed! I have a hand full of options I am looking into at this point, but I can’t go see the midwives I was with because their backup OB practice won’t take me on… I have an appointment with a high risk Perinatology group who seems to be open to my request, but the two words high risk scare me because I know it is going to limit the availability of a natural birth. Although the positive of it all is a friend of mine, who had two home births, and came down with a horrible blood disorder during her third pregnancy had a 100% natural hands off birth with this same practice. So… I have hope…

We’ll see!

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10 comments

tags: acog, OB/GYN, press release, recommendations, VBA2C, VBAC
category: Uncategorized

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1

By: Blair Twitter: @blairlovesjason

Wishing you the best. I have onlyhad one c-section, but have had serious gestational diabetes and required insulin in both pregnancies. This makes me extra-special risky in most provider’s eyes (yay me). In fact, there was a survey that was presented at NIH about barriers to VBAC and in that survey, of the few respondents who did VBACs at all, something like 87% would not allow a GD mama a TOL. Being a VBA2C mama, you may have a fight on your hands, although I hope you don’t. You know the facts and based on what I have read here I think you will be a great advocate for yourself. Wishing you the best and a safe and peaceful VBAC!
Blair´s last [type] ..One Mans Trash

2

By: The Deranged Housewife

I’m in the same boat as you, only I’ve had a VBAC in between two sections. I don’t even know if I want to go back down that road again. because I have a history of PIH and breech presentation. My first just grew into that position because of a uterine malformation, but my last was vertex until the end, and that’s what scares me the most – how to deal with a possible cesarean if I have another breech baby. I’m not sure I’m even a candidate for a version because of all my risk factors, and I don’t know if I could handle another section emotionally .. it all feels like such a gamble.
The Deranged Housewife´s last [type] ..Being censored- by your OB

3

By: Kristin Twitter: @Atyourcervix78

Danielle!! You seem surprised!! OBs listen to no one!! Afterall, they are doctors, if not gods, and they know, everything!!! Sarcasm aside, I wish you the best. I will be praying throughout your pregnancy that you get the birth you want. On a side note, we had a mom come into the hospital at my last employer by squad who accidentally HBA2C when the obs wouldn’t ‘let’ her VBA2C. Healthy pregnancy and happy birth vibes your way!

4

By: Roxanne

Good luck mama! I have already had a successful VBAC (had to drive 3 hours to find a supportive provider), and am currently pregnant and planning my 2nd VBAC. Maybe you can do what I am doing…which is see a midwife for prenatal care until about 30 weeks which is when I will switch over to the OBGYN that delivered my last baby. For me, it makes it alot more hands off, low-stress, and of course, I don’t have to drive 3 hours for every appointment. Good luck!
Roxanne´s last [type] ..Dear Friend Wenatchee Maternity Photography

5

By: Laura

I have had several doula clients who did a VBAC @ home with an experienced home birth midwife. If you feel strongly about this, you can find a provider that will help. I do know a midwife that will travel to come and attend your birth @ home.
Feel free to contact me if you want more info. about this.
Wishing you a smooth ride, and easy birthing.

6

By: Danielle

Thank you Laura. I have discussed this with my husband at length, but with his feelings, and my previous births, we just don’t
feel comfortable opting for a home birth. I wish I would have gone for a home birth with my first VBAC attempt before having a
second scar.

7

By: Katie Twitter: @Capebabylady

Something I stumbled upon that might be of interest to you Danielle.
http://boards.medscape.com/forums/?14@942.MoPpa2Yux5n@.2a026287!comment=1&show=results

Click on Poll Results. Sad, very sad.

8

By: preconceptionist Twitter: @preconceptionst

That must be so frustrating! Definitely not good for the stress levels. It’s a shame it takes so long to align practice with evidence. Did you see that ACNM released a statement about a week ago saying the new ACOG guidelines aren’t likely to make much of a difference in women’s access to VBAC? http://www.midwife.org/documents/ACNMResponsetoVBACBulletin_082610FINAL_000.pdf
preconceptionist´s last [type] ..Are First Trimester Sonograms a Good Idea

9

By: Maya Twitter: @MarfMom

I have a girlfriend preparing for a VBA2C and initially she was told not allowed to try, but just this week found an CNP midwife who is going to back her up and help her push the OBs for it. I am so excited for her, and I hope you have success with this OB you are going to meet. The perk to a VBAC means less of a chance of being pressured for induction I guess, since those are pretty strongly contraindicated. Or at least, I’m telling myself that will help them to not pressure to induce me!

One thing I recently read about but hadn’t considered (re: AGOC guidelines being followed) is that some insurance companies aren’t allowing VBACs still. There are OBs who want to do them, but their malpractice insurance is ignoring the new guidelines and research, which is frustrating to both them and their patients. I wonder how insurance companies could be convinced to get on board?
Maya´s last [type] ..Lactivism

10

By: seaj

I would like to comment because I was in a situation very similar to yours this time last year. We found out we were having our third baby and I too had had two previous c-sections. I wanted to attempt a VBAC and was willing to deliver in the hospital but had an extremely difficult time finding a provider to cover me. I was referred after our third attempt at an OB to a high risk perinatal group that practices in a hospital that I knew was at least VBAC friendly.

They had a great practice and provided me with the risk vs. reward on VBAC info that I had already covered a million and one times. We were “allowed” a TOL and we were blessed to have a 100% natural VBAC this summer. In the end it does not feel as if they allowed me to do anything. It has so much to do with empowering yourself and truly examining if you are a healthy candidate and if you are then go for it! ACOG’s recent statement also says that you can no longer be denied a trial of labor even after two c-sections.

I wish you the absolute best and I hope that you can find a provider that supports your wishes. There were some in the our perinatal practice that supported us and some that did not. But WE knew what WE wanted and we were steadfast in our beliefs and feel lucky that things worked out as they did. Either way it was important to us, to me, for our baby to at least try. It is worth it – it is that much better! god bless

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