Category Archives: VBAC

Defining Active Labour

A quick snippet here, finally it is starting to become common practice to start counting active labour as 6cm dilated, instead of the 4cm previously used as the measure of success.  Stepping aside a little from the debate over whether measuring a cervix is a helpful thing to do at all, this is a positive move for women and babies.  As early labour can take a long time for many women, and it is prone to starting and stopping for quite a few, this could make a big difference to the numbers of women who are diagnosed with stalled labours at 5cm and who end up with their labours artificially accelerated or having caesarean surgery.  This is particularly important for women panning a VBAC who may have had their primary caesarean for a stall at this point, or who got to the end and they or their babies were exhausted from an artificially hard labour.

Science and Sensibility have written a great post about it, which is here.

Abortion, Birth, Choice – Who should get the power to decide?

There is a politician in Ohio, State Representative Jim Buchy, who is campaigning to reduce or even ban legal abortion in the state of Ohio.  He is co-sponsor of the ‘Heartbeat’ Abortion Ban.  When asked by an Al Jazeera reporter why he thought women might want an abortion he replied, ‘I’m not a woman, it is a question I’ve never even thought about.’  Yes, that’s right, he is making plans for a woman’s body and he has never even thought about why she might want that choice.

Regardless of what you think about abortion, in order to present a half-way reasonable argument it would seem vital that you consider both woman and child, that you consider carefully the reasons why women are making those choices and the pressures on them, socially, economically, physically, emotionally….  The ironic thing is, that there are some who seek to protect the life of the unborn by killing abortion providers, I’m not going to say any more about that than I can’t buy into their reasoning…

It seems obvious, doesn’t it, to ask the questions…  Yet these are the kind of thoughts I hear WAY too often in my job…

Why would a woman want an abortion? Why would she want a VBAC? Why would she want a peaceful, undisturbed birth with a carer of her choice rather than just the next medic on the rota?

Before you tell her why she can’t, ask yourself why she might want to.  Some days I feel like I am clashing heads with those who have not even considered that there is another side to the debate, and that is why women need support that IS up to date, confident and actually aware of not only both sides of the debate but the evidence that informs it.

When women are asking for home birth, VBAC, choice of carer or birth place, when they are declining induction, monitoring or a stranger’s hands in their vagina, instead of telling them it is for their own, or their baby’s good, just stop for a moment, and ask yourself, ‘Why might they want that choice?’

Happy Birthing
xxx
Vicki

The full Al Jazeera report, The Abortion War is on YouTube, with Buchy speaking 11:47 into the film.

Uterine Rupture

I think the negativity and shroud waving is not helping women to make the decisions that are right for them, and I firmly believe that care providers who deny women choices and options are the ones who should be struck off, not those who help women to do what feels right for them. Our health care system is in such a mess and so many women are getting truly awful maternity care not because women or babies need it but because care providers are frightened of lawyers.

It is not reasonable to pretend that it is a choice between mother and baby or life and death. A woman’s ‘experience’ or her baby’s ‘life’ because the two are inextricably linked. Mothers do not willingly and knowingly put their babies at risk, but each will make a different decision based on too many factors to say what is ‘right’ because, what ever happens, the woman carries the burden and not those who cared for her or steered her decisions. For that reason it can only be the woman’s choice what is done to her body and she has to take ownership of that choice and be comfortable with it.

Care providers are so filled with fear, and that fear is affecting the women they care for, in attitude and in denial of choice. A section rate of one in three is indefensible, and at that rate is causing MUCH more harm than good.  It always strikes me as staggering that women are talked out of a VBAC by clinicians presenting the statistic that VBAC carries a 0.5% chance of rupture, and yet women who are being encouraged to accept induction are rarely told that induction carries the same 0.5% chance of creating a hole in their uterus.

It may well be that the risks of VBAC and PAR are actually MUCH lower than women are being told, and the article Uterine rupture is rarer than previously thought by Professor Marian Knight of UKOSS (UK Obstetric Surveillance System), published by NPEU (National Perinatal Epidemiology Unit, University of Oxford), would appear to back that up. If women are really re-rupturing at the rates often quoted then their ruptures are not being repaired properly.  True ruptures are rare, catastrophic ones even more so  Often the term ‘rupture’ is used to describe benign scar separations, dihesences and windows, which aren’t a risky thing for mothers or their babies, and women are left confused by what they have been told about the state of their scar or uterus.  The book Silent Knife is really a very good read for stats, descriptions and discussions of pregnancy after caesarean surgery.

So often when women are being told of the risks of VBAC uterine rupture is presented as a grave danger.  However, women are rarely told that the risk of losing their baby to amniocentesis is three times greater, and they are rarely, if ever, told about the dangers associated with repeat caesarean surgeries.  That includes the very real and present risk of problems with placental attachment.  If you want to read more about this, the great resource Science and Sensibility has done a good job of covering placenta accreta it here.

There is good research to say that tears heal better than cuts (http://www.ncbi.nlm.nih.gov/pubmed/10422908) and so a repaired simple rupture (no healed edges to the hole, no placenta involved) should be stronger than a second planned section scar from an incision by knife.  This is clearly being taken on board, because many surgeons are now using ‘blunt extension’ techniques, which in effect means separating the uterine muscle by tearing it along its natural planes, which leads to a stronger repair and less trauma to the tissue.

I was told that a re-rupture was a certainty because my uterus would never stretch round a baby… Clearly that was a crystal-ball prediction, because it did just that and we were considerably healthier in my PAR than after either of my caesareans. That in itself has enormous benefits for the whole family!

I’m expecting that most of the re-ruptures are women who have had windows and scars that have opened during the trauma of a repeat section. We don’t worry about any other scar or injury to the same extent. I think that the ‘dead baby card‘ is just out-and-out blackmail. So few women carry a PAR (because most get a hysterectomy and the rest are told not to try again, of which a significant majority will heed that advice) that we will never have big enough studies to know what the numbers really look like.

I have been told repeatedly that no one has a baby after a rupture, well clearly I did, and I know others who have, yet it does not stop medics from telling woman that their experience is a universal truth, it isn’t, any more than mine is.  Women do have babies after uterine ruptures, yet many are told that it simply isn’t possible.

It is so wrong to tell women that if their babies die it will be their fault and that surgery will save everyone, because it doesn’t and it won’t.  Women have to make the choice that is right for them, it is their body, only they can decide…

If you want to read other thoughts on VBAC and rupture, have a look at birthing beautiful, there are some really good references!

xxxxx