Reply turned post, advice on VBAC in rural New Mexico?

I replied to a post on Shakesville in which a community member who is pregnant after a prior cesarean asks for advice in seeking a VBAC in rural New Mexico, when the nearby hospitals have a no VBAC policy.

This is my reply:

You can contact me at hilseb at gmail dot com, if you’d like. I know a bit about this. I am in medical school, and am planning to be an ob/gyn. I am doing a research fellowship on obstetrics right now. I am a big proponent of evidence based medicine, which means I am a big proponent of VBAC.

Here is a link to all the blog entries at my blog I have written on VBAC. That’s just the first page. Click on older entries, and the list goes on. Just to give myself some cred, if my alleged bio doesn’t.

Here (pdf) is the incredibly recent, like published last month, and very thorough NIH evidence report on VBACs, which concludes “This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans.”

Here is an excellent academic article on risk and pregnancy written by the American College of Obstetrics and Gynecology risk task force that has some very supportive language on offering VBAC and how to present risk to obstetric patients. According to this article, “Although rates of delivery-related perinatal death are indistinguishable between VBAC and primary vaginal delivery, there is a genuine differential in the rate of uterine rupture–related hypoxicischemic encephalopathy. Such perinatal morbidity is indeed devastating. It is also extremely rare. In a recent large prospective study, the probability of this outcome was 0.00046 in infants whose mothers underwent a VBAC trial at term compared with no cases in infants whose mothers underwent repeat cesarean delivery.” (emphasis mine)

Here is the website for ICAN, the International Cesarean Awareness Network. Here is their page on VBAC. Here is their VBAC reading list. Here is their database on hospital policies on VBAC. Here is their FAQ on how to face a VBAC ban. Unfortunately, there is no New Mexico chapter listed on their site, but there is a national group, an AZ group, and lots of resources available.

Here is a link to my buddy Jill’s incredible blog, the Unnecessarean.

I have been to many, many beautiful VBACs, most of which were successful, safe vaginal deliveries, which goes with the 75% to 80% “success” rate numbers abundant in the literature. Even the ones that ended in a cesarean were happy, healthy births that fit the informed consent of the pregnant person.

Please, please, don’t hesitate to contact me, if this post hasn’t overwhelmed you.

*****************************

If anyone else has any advice, please comment at the original post at Shakesville.

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4 Comments

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4 responses to “Reply turned post, advice on VBAC in rural New Mexico?

  1. MTF! you are a gem, a real gem! This is a great bunch of resources! Just feeling the need to say that! Can you hop on a plane and come out to the REACHE conference this friday in Seattle. You would love it!

    http://www.reache.info

    Sharon

  2. Raquel Quintana

    I also live in a small farming town in Southern New Mexico and my OBGYN told me the local hospital cannot do a VBAC. I would have to go to Albequerque…about 4-5hrs away. But I wondered if even going up there, my attempt to have a natural birth after a C-section would be too risky since i became pregnant with #2 only 13 Months after #1 was born. Would my scar tear open before I reach full term…do I need to look at being induced early? I’d love to have a natural birth this time…but last time he just wouldn’t come out cause they said I was too small and wouldn’t dialate past a 6 after 15 hours in the hospital with STRONG contractions.

    • MomTFH

      Induction is generally not recommended for trial of labor after cesarean (TOLAC). Full term pregnancy is not linked to uterine rupture vs. “early” delivery (what would “early” be? 37, 38 weeks?) Rupture is linked to scar type (low transverse being the most desirable), induction (cytotec being the worst type), and other factors. If you became pregnant after 13 months, then you will be delivering with almost 2 years in between. That is a pretty decent amount of time.

      Not dilating past a 6 may depend on a few things. Were you induced that time? What did you start at? (i.e. what was your Bishop score?) Being “too small” shouldn’t affect your dilation – it was arguably affect your risk of shoulder dystocia.

      I would find a VBAC friendly practitioner and do a consult and investigate your options, if you are interested in pursuing TOLAC. Make sure you have as complete a copy of your records as you can get, especially your operative report. Good luck!

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