Tag Archives: VBAC

Reply turned post, I reject your reality! style

OK for Mythbusters, not for health advocacy

I have been participating in the Facebook group VBAC Facts Community for a little while now, ever since meeting the wonderful community founder Jen Kamel at the VBAC Summit last year. It is a supportive group, and Jen runs the site well with the help of moderators and a good foundation of evidence.

This group, at times, can be a good example at how distorted internet microcosms can make uncommon opinions seem much more accepted. In this community, using midwives and having a home birth comes up in almost every thread, it seems. I have seen using a midwife treated like a hipster fashion choice recently on Jezebel and other sites. However, midwife attended births still make up less than 10% of births in the United States. Hardly a huge trend. Midwives are underutilized here compared to many other countries with better maternity and neonatal outcomes than we have. But, depending on your source, midwife attended and/or out of hospital births may seem to be common or even a glorified standard. However, in the circles I travel in my daily grind as a physician, choosing out of hospital birth is fringe, reckless behavior.

So, it’s like entering a portal in another world when I participate on a thread in the VBAC group, and the commenters have a heated argument about epidurals, and many participants did not get one. On our labor and delivery floor, it is a rare to never occurrence that someone wouldn’t get one. Because out of hospital birth, choosing not to have an epidural even if you deliver in a hospital, and VBAC are such rarely available, rarely supported choices, I am usually on the side of defending people who advocate for such choices as underdogs, not the holier than thou bullies that many paint them to be.

It’s also a really strange place for me to be in when I gently try to correct medical inaccuracies, and I sometimes get painted as a brainwashed surgico-technocrat physician. I correct fellow physicians when they say all VBAC is dangerous. For real, even my attending physicians. I also have corrected fellow physicians who state episiotomies are preferable to tearing. But, I also correct women in the VBAC group who state things that are medically inaccurate, like that worsening hypertension in pregnancy is not serious and does not warrant an induction or cesarean unless the fetus is in distress, or that leaving the hospital midlabor is a reasonable course of action if one is faced with unwanted interventions (in one particular thread in which I was painted as a typical brainwashed South Florida cesarean happy physician, the intervention that warranted attempting to leave midlabor was continuous external monitoring).

These are not the majority opinions even in this microcosm. But, they are often aggressively defended positions. One that has come up repeatedly, recently, is an insistence that tubal ligation is linked to “post tubal ligation syndrome”, which leads, according to some posters, to the majority of women needing hormonal interventions to control heavy menstrual bleeding, and / or hysterectomy to control intractable post procedure pain.

I think these communities are incredibly valuable, not just because of the sharing of strictly evidence based facts. I think a lot, even the majority of the benefit is the support and stories from other women who have experienced similar choices and situations, or share similar priorities and stories. I think in the VBAC community, and in pregnancy and mothering as a whole, there is so much value to support, empathy and stories. However, there is a big difference between asnwering an original poster who says “what was your experience with tubal ligation?” and someone answering “geez, I had pain and menstrual irregularity after” and an original poster saying “I am planning on a tubal ligation” and a slew of commenters saying “NO! This is PROVEN to cause a, b and c horrible side effects to the majority of women who get it!” and usually a touch of “Have you considered Natural Family Planning?”

Sigh.

I have reluctantly been the heavy in many of these conversations, but it is triggering a bunch of pet peeves of mine. 1. Medical inaccuracies masquerading as facts. 2. Ignoring the expressed informed choice and priorities of the woman posting and substituting the commenters’ own priorities and (often faulty or anecdotal at best) information

So, this coalesced into a recent thread, and here is the reply I posted:

“This is the best article I have found on post tubal ligation syndrome:

http://www.nejm.org/doi/full/10.1056/nejm200012073432303#t=articleResults

It is a good article because it compares women who have had tubals with women whose partners have had vasectomies. It is also a good study because it has an N number of over 9,000 subjects who had the tubal ligation. It is also authored by a group from the Centers of Disease Control (the CDC). There is no economic conflict, and the New England Journal of Medicine is about as high quality a publication as it gets. Here are the results:

“The original concern about sterilization involved the risk of heavy bleeding and intermenstrual bleeding, but we found no evidence of either problem. Furthermore, we found that women who underwent sterilization were likely to have decreases in the amount of bleeding, the number of days of bleeding, and the amount of menstrual pain and an increase in cycle irregularity. We know of no biologic explanation for these changes, most of which were beneficial, in women after tubal ligation.”

I don’t think there’s any evidence of widespread issues post tubal. In fact, this high quality study seems to indicate the opposite. I am not saying a tubal ligation is right for everybody, but I do think it is inappropriate for every thread on here in which tubal ligation is mentioned to devolve into a pronouncement that tubals are PROVEN to cause these problems, often with alarming figures like half of all women who get tubals end up with hysterectomies, etc.

As I have also said, it is inappropriate at best and borderline bullying at worst for women on here to disregard a woman’s stated informed choice and substitute their own priorities, especially if they are coming from a place of anecdote and questionable information. It is also inappropriate to ignore a woman’s expressed desire for a highly effective form of birth control (like a tubal or IUD) and to tell them to try NFP* instead, when it has a typical failure rate much higher. I hold a woman’s right to make informed decisions about her reproduction to include highly effective birth control if desired as well as safe options for trial of labor after cesarean.

I am not a surgery lovin’ medicoindustrial defending brainwashed doctor. I trained as a midwife, had both of my kids unmedicated** with midwives, and have never used hormonal birth control myself due to my own priorities and reasons. I support low intervention birth and VBAC for two main reasons which may seem contradictory, but are wonderfully not. 1. It’s a woman-centered approach and 2. It is an evidence based approach. Bullying women into avoiding their choice of safe contraception is neither.”

*I love this site for comparison of contraceptive methods: http://www.birth-control-comparison.info/
**The first labor was augmented with pitocin without my informed consent, but was otherwise unmedicated

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Breaking the silence

I am happily coming down off the high of presenting at the Medical Students for Choice annual conference – I was part of a fantastic panel on Protecting Choice in Birth. I felt honored to be sharing the table with some brilliant people – two wonderful ob/gyns, two reproductive justice lawyers, and little old me. We talked about the legal and ethical underpinnings of patients’ rights and choice in birth: site of birth (e.g. out of hospital birth), VBAC, even use of a doula or refusal of certain interventions.

It was a wonderful experience. The director of MS4C told us the response was so overwhelming that the conference was buzzing about our panel, and we are definitely invited to return. I learned a lot from my co-panelists, and loved the enthusiastic response from the audience. One sweet medical student literally had his jaw agape when Farah Diaz-Tello, from the National Association for Pregnant Women, described a woman who had her baby taken away and put in foster care for simply wanting to postpone signing a blanket consent for any intervention or procedure during her labor and delivery. She had a healthy, spontaneous vaginal delivery with no complications during her SECOND psych consult (after the first psychiatrist deemed she was clearly mentally competent and allowed to refuse consenting to an unnecessary hypothetical cesarean), and apparently her six year old is still not in her care due to the red tape surrounding her case. Jaw dropping, indeed.

I talked about my journey, including being a patient, mother, midwifery student, doula and research fellow before becoming a doctor. I discussed the hostile-to-patient-autonomy atmosphere in South Florida, my fellowship research on labor interventions, and how to present risk to patients.

I almost burst into tears when my co-panelist, the lovely and dynamic Dr. Hanson, showed pictures of twins and breech births she has delivered all over the world. I did end up tearing up during lunch, not just because birth is moving and emotional, but because I am slowly accepting that I will most likely never be doing these difficult deliveries, and my wonderful copanelists innocently asked me about my residency plans. I may not be doing deliveries at all.

I got a decent amount of invitations to obstetrics residency programs. I am slowly canceling them, one by one. I simply cannot justify moving my two boys to a city where I don’t know anybody, then disappearing to work my ass off 80 hours a week at all times of day or night. I also don’t want to put them in public schools in the Deep South. When I got divorced during my third year of medical school I knew that would mean facing residency as a single mom. The divorce was worth it, but now that I have experienced the reality of how hard internship is, even with significant family support in my home town, I had to reconsider my options.

I will most likely be pursuing a family practice residency at a local residency program, probably at the hospital where I am doing my internship. Yes, obstetrics can fall under the family practice umbrella, but I would be the first family practitioner to get hospital privileges in the greater Miami area in recent or remote history. In other words, the chances of that happening falls between not likely and impossible. Yes, not even if I do an obstetrics fellowship, which would involve leaving town for a year. It’s just not the standard of care here, even if it’s normal in other parts of the country. And my custody arrangement stipulates that I practice here after training. So, even if I move for residency, I would have to uproot again and come back.

I can still do women’s health. I can still do prenatals. I can do lactation medicine, including the pediatrics portion. I can even be the medical director of a local freestanding birth center, just not their backup surgeon. Which, honestly, was never a huge draw for me. I want to be at the normal pregnancies, not a back up for the ones that go wrong. I can do family planning. I can still do academics, including medical ethics, which is an interest of mine.

So, most of the time I am ok with this. Most of the time. I have a lot to be happy about. I have great kids, good family support, a supportive director of my residency program, relatively good health, friends, a cute little house, a fuzzy loyal dog, and a blossoming (very tentative!) new relationship with a nice guy. And I’m a doctor, for Chrissakes. With a job in a shitty economy.

So, anyway, another permutation on the journey. Let’s see how it plays out.

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Preventing primary cesarean

Hi! Internship has been keeping me busy. So has getting together my presentation for this year’s VBAC summit. I had an hour and fifteen minutes to talk. I went over, and I still didn’t cover half of what I wanted to say.

The First Cut is the Deepest. (I can’t figure out how to embed the viewer.)

You can find the mp3 to hear me speaking to go along with the presentation. I explain. A lot. I also tell funny stories, horrible jokes, and pass out chocolates. Sorry, the chocolates are not available through the internet.

MP3 of me: https://www.wepay.com/stores/vbac-summit/item/preventing-primary-c-sections-what-you-need-to-kno-717302
MP3s of all of the presentations: https://www.wepay.com/stores/vbac-summit

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Reply turned post, from abortion to homebirth style

Hello! Hey, I’m a doctor!

Please go read this excellent article at RH Reality Check: Why Birthing Rights Matter to the Pro-Choice Movement.

Here is a great quote from the author Laura Guy, who is a doula (yay!) and a certified lactation consultant (IBCLC) (double yay!):

But let’s be clear about something. Reproductive justice means that everyone has complete control over if, when, where, how, and with whom they bring a child into the world. It means that people have accurate, unbiased access to information regarding all facets of their reproductive lives, from contraception to pregnancy options, from practices surrounding birth to parental rights. It means that our choices are not constrained by politics, financial barriers, or social pressure. In other words, how can the right to give birth at home – safely and legally – not be on a reproductive justice advocate’s radar?

As I commented on the article, I was thrilled when, during the keynote address at my first Medical Students for Choice meeting, the speaker mentioned out of hospital birth. Reproductive rights are full spectrum. They start before sexual activity begins – bodily autonomy begins with birth, stretches through childhood with protection from oversexualization, extends through accurate sexual education, includes contraception and freedom to choose when and how to become sexually active, and definitely doesn’t end once one decides to carry a pregnancy to term. The ability (or lack thereof) of women to choose the site and mode of their delivery, among other important issues of autonomy during pregnancy, are key ways that women’s rights are challenged daily in this country. Pregnant women are not human incubators.

So, seems like a bunch of mutual appreciation society activity here. Where is the angst that usually prompts the reply-turned-post? Well, on the RH Reality Check link of Facebook, one commenter says: “This is great and it’s also important for women to have the right to medical interventions (like elective C-sections) they feel are right for them.”

Here is my reply:

‎@Kathleen – within reason. Feeling something is right is one thing, but unnecessary medical intervention is not a “right” per se.

It’s a very nuanced issue that may not fit well in the comments section on Facebook. For example, evidence and expert position statements warn against early induction. Feeling like an induction is right is not enough of a reason to get one. Take it from someone who has been in the paper gown, sick of being pregnant, and in the white coat – many women feel like an induction before the end of pregnancy.

Also, someone who is a really poor candidate for vaginal delivery (placenta previa, for example), may feel like they want a vaginal delivery, but it is not medically advisable. Same goes for women who are poor candidates for homebirth. I think homebirth is an excellent option for good candidates. Not all. There is a role for practitioners to play here, too.

As a physician and most likely a future ob/gyn, I will be one of many practitioners who need to constantly work that balance between respecting a patient’s autonomy, providing good informed consent, and practicing good medicine with a good conscience. Medicine is more than ordering off a menu.

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Reply turned post, blame the mom or the system? style

My buddy Jill of The Unnecesarean has launched an awesomely Rad Pitt (inside joke, you’d get it if you were from San Diego or South Beach) new project called CesareanRates.com. She shared a top ten list from my lovely state of Florida on Facebook, which got, as expected, an avalanche of disgusted responses.

It is hard not to see rates of 50, 60% + without choking on your third cup of coffee. OK, maybe I’m the only one on my third cup of coffee. And I didn’t really choke, since I was well aware that some hospitals down here have had rates higher than that, as you can see by Jill and my silly little guerrilla action here, which was when we first became partners in crime.

Well, in the flurry of comments on her Facebook page, many people followed the familiar line of – blame the moms. Blame the women for not educating themselves. Blame them for choosing a hospital birth over a homebirth. Blame them for being all Hispanic (Mexicans and Brazilians in particular were blamed for our cesarean woes) and wanting a cesarean. Blame them and the OBs for creating an atmosphere of fearing birth, and forget about changing that system, because it’s a lost cause. There are plenty of good replies to this, but I am sharing mine here:

OK, diving in. First of all, the Mexican and Brazilian population in Miami and Broward County is pretty low. Cubans are by far the majority of the Hispanic population. Also, research shows that maternal request and ethnicity as factors influencing primary cesarean are both way overblown.(1) In fact, some research indicates that being Hispanic decreases your chance of having a primary cesarean in the United States.(2)(3)

Training as an OB in residency and insurance are not the primary reasons why OBs in South Florida don’t want to do VBACs. My assertion is based on as yet unpublished research from my fellowship project. Residency sites are probably the most consistent place you can get a VBAC in Florida – note that someone on this thread is going to do a VBAC at Jackson, which is the only OB residency in South Florida. Most OBs cite malpractice concerns as their reason for not doing VBACs, and that was very consistent with responses in my research. And, no tort reform is not the answer, because Florida has had some of the most extensive tort reform for OBs in the whole US – OBs here can and often do “go bare”, which means they don’t even have to carry malpractice insurance, and can limit their liability totals in various ways. Jackson has immunity as a public hospital, also.

I have to say, I am not fond of blaming moms, either for their site choice or their cultural backgrounds. I also don’t think it is effective to turn our back on changing the system. As Jill said, almost all women choose to birth in hospitals. Even with out of hospital birth rates increasing, we are still talking rates around 5%. Of course, I have to believe on changing from within, or else my life’s path is a waste of time.

(1)http://www.childbirthconnection.org/article.asp?ck=10372
(2)http://www.ncbi.nlm.nih.gov/pubmed/19788975
(3)http://mchb.hrsa.gov/research/documents/finalreports/declercq_r40_mc_08720_final_report.pdf

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Much more fun than studying

I am cramming for my last exam in medical school tomorrow. Scratch that, I am procrastinating instead of studying. I will be speaking at the VBAC Summit again this year, and had to write a bio. As much as I didn’t want to write about myself, it was much more fun than studying.

Hilary Gerber is a pre-doctoral research fellow who will be graduating from medical school in two weeks. After completing a traditional internship, she hopes to specialize in obstetrics and gynecology. Her fellowship research focused on evidence based labor and delivery interventions. Before medical school, Hilary gave birth twice with the help of midwives, once in a hospital, and once at a free standing birth center. She would love to have a home birth if it didn’t involve having another baby. She trained as a direct entry midwife and worked as a doula. Her article “Social Media, Power, and the Future of VBAC” was published in the Journal of Perinatal Education. Her sometimes dormant blog “Mom’s Tinfoil Hat” is not peer reviewed, however. She also has a studio art degree, has delivered pizzas, worked the graveyard shift at Denny’s, wrote a parenting blog for Mtv, and was in a band that is in the Rock and Roll Hall of Fame.

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Lamentations

Please, run, don’t walk, to the series called Lamenting the System at the Unnecesarean. It is a series of responses from practicing ob/gyns to an article called “An Obstetrician’s Lament” by Annette E. Fineberg, MD, which was published in the Green Journal (ACOG’s Obstetrics and Gynecology) this month. The Navelgazing Midwife reproduced the article in its entirety here.

Jill, blogmistress (I love that word!) at the Unnecesarean sent me a copy of the original article right before she started the series. It couldn’t have been better timing. My attending physician (in my pediatric ER rotation) was giving me a similar lecture to one I have gotten from almost every physician I have worked with – a lecture about what the “real world” was like, and how, in the “real world”, you couldn’t afford to offer VBACs. I argued about how VBACs were no riskier than primary vaginal deliveries, and how refusing to allow them flies in the face of expert consensus and ethical responsibility to the autonomy of the patient.

Then, I got the email from Jill. I eagerly read passages aloud to the intern sharing the service with me. She is a good friend and is leaving to start an ob/gyn residency in July. She is kind and open minded, but she did not have the benefit of training in a freestanding birth center with lots of spontaneous, natural births and plenty of successful VBACs, like I did. She has been subjected to as many if not more lectures on the “real world” as I have, and has probably only seen conventional hospital births with all of the constraints and interventions of modern obstetrics.

I read many passages, to her, including this one:

Each of these women deserves an honest discussion about the fetal and maternal risks of each birthing option. However, our lack of experience as obstetricians colored by our fear of liability is narrowing women’s choices, and sometimes motivating them to ignore fetal and maternal safety in an effort not to be coerced into unnecessary interventions. I sense a mounting tension, because many obstetricians do not have the willingness, time, or skills to provide maternal choices.

All of the articles in the series are good, but I especially love An Obstetrician’s Hope, the last one in the series, by David Hayes, MD. Every word in his piece spoke to me and to the type of practitioner I want to be. On the one hand, I am overjoyed to read of a physician supporting and attending homebirths, and even happy to see more obstetricians who support and attend homebirths in the comments. I am saddened, though, that he is leaving his practice here (although joining Doctors Without Borders is fantastic for him and the people he will help).

Here is an excerpt:

A woman choosing to have a home VBAC rather than be forced to have a repeat C/S in her local hospital is making a rational decision given the data we have available, a decision which we should be prepared to support if we cannot offer her a better alternative. I have delivered several hundred VBACs in the past several years without incident. In the same time frame, my local hospital has lost at least 3 mothers during or shortly following cesarean deliveries.

U.S. obstetricians have already come to the crossroads and have taken the wrong path. It can be fixed, but they need to start having honest and open discussions among themselves about the real maternal and fetal risks, about the rampant rate of unnecessary induction which leads to unneeded cesarean delivery, about the continued use of continuous fetal monitoring, restricted movement, withholding of nutrition, unneeded augmentation of labor, artificial rupture of membranes, epidural anesthesia and even multiple cervical exams, none of which have any proven benefit and all of which contribute to increased morbidity and even mortality.

Please go read the whole article, and the rest in the series.

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So, I’m still here

Again I find myself apologizing for the blog silence. There are a few reasons I have been quiet.

First of all, my ex has been reading my posts and complaining to players in our divorce about what I write on here. So, I am not writing more about our divorce on here.

Secondly, I have been pretty busy. I have been doing the holiday thing with the kids, family and friends. I did get a few days off work. I am actually pretty happy to get back. I am enjoying pulmonology, and may look into doing a 4th year elective with the same attending physician. I am getting pretty good at ABGs.

I am not so good at EKGs. I did a module on EKGs using this ECG Wave-Maven, and I am really confused by a 5:4 AV Wenkebach. I could spot the MI’s, which is a relief, I guess.

So, there is more stuff I wish I had the energy to talk about. Mtv had an episode of “16 and Pregnant” called No Easy Decision in which one of the teen moms gets pregnant again, and decides to terminate the pregnancy. I have not seen it, but I think there are actually three young women who discuss choosing abortion. From what I have heard, it is a well put together show. Exhale has put together a site called 16 and loved that supports her coming forward with her story.

California Watch published a report entitled “As early elective births increase so do health risks for mother, child”. Thanks to Jill at The Unnecesarean for covering this.

CNN had an article on CNN.com called “Mom defies doctor, has baby her way” about a woman who had a home birth VBA3C (vaginal delivery after 3 cesareans). She was alternately painted as reckless and also as having no other option. How is a woman supposed to have a VBAC in a facility “with staff immediately available to provide emergency care” if practitioners who deliver in these facilities refuse to attend VBACs?

Anyway, I’m back, at least for the time being. I hope my son’s guardian doesn’t tell me he got an earful about my blog again. I am not airing all of our dirty laundry on here. Believe it or not, this is reticence.

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Reply turned post, a VBAC reality check

I am a huge fan of RH Reality Check. However, I was recently a little troubled by a post about choosing elective cesarean over attempted VBAC (vaginal delivery after cesarean). I am a little, OK way behind on my blog reader. The original article, I’ve Made My Birthing Choice, and It May Surprise You was published in September, but I just got around to reading it tonight. I had a gut reaction similar to the reaction I have to many blog entries I have read defending a common, mainstream choice that is disguised as an underdog, against the system, authority challenging choice. But, I was more troubled by the many medical inaccuracies in the piece.

So, I wrote a reply. One I am upset to see has a bunch of html fail in it. I guess RH Reality Check doesn’t support hyperlinks. So, here is the prettier version:

I want to support you and your decision to have a repeat elective cesarean instead of a VBAC attempt, and your choice is indeed valid.

I have to join in the chorus challenging some of your points, however. On the one hand, I am hesitant, since I cringe at the thought of how judgmental people are towards pregnant women and their choices. However, there are a few reasons why I am choosing to do so. First of all, I think you have some statements in your article that are medically inaccurate. And, this isn’t a personal blog. This is presented as journalism / advocacy. Journalism on medical topics needs to be held to a higher standard.

Secondly, you are defending a choice, elective repeat cesarean, that is really not in need of defense – it is presented as the most reasonable choice, and in many cases only choice, for the vast majority of women in the U.S. The power balance is dramatically tilted against women being able to choose VBAC. How is it surprising that it was your choice? Of course it’s valid – it’s almost guaranteed!

Let’s start with some of the inaccuracies.

I am in medical school and just completed a research fellowship on labor interventions. I think the exercise you did in your childbirthing class was atrocious. We do not need to choose between a healthy baby and evidence based, women centered medicine. Avoiding non-evidence based interventions that have worse outcomes for the mother and baby makes it more likely that we can have healthy babies. They should not be presented as competing priorities.

For example, we can have a healthy baby AND not have an episiotomy. Episiotomies should be avoided at all costs, according to substantial research. They do not make babies more healthy. There is not one situation in which they save a baby’s life. It is even recommended that they be avoided for operative vaginal delivery (when an intervention such as vacuum extraction is needed) – they lead to more maternal and neonatal morbidity. I consider episiotomy use to be a litmus test for an obstetrical health care practitioner.

As other people have pointed out, non medically indicated inductions, especially those in a first time mother, carry more than double the risk of cesarean. In fact, some hospitals are now banning elective inductions on first time moms as a quality assurance measure. Rixa has a good synopsis of links on this topic at Stand and Deliver. The Bishop’s score is an important indicator of whether an induction is likely to be successful, as opposed to a several day long ordeal that ends with a cascade of interventions, leading to an emergency / iatrogenic cesarean. If there is a compelling medical indication that one would get a cesarean for anyway, that is one thing. But, in our society, many women are told to get induced before their baby gets to big, or because the baby is looking a little small, or because the obstetrician is going on vacation, or the calendar year is changing, or because they have a certain amount of time off from work and they really want to plan their maternity leave. These psychosocial factors for induction are all indeed valid, and birth is not the only medical decision in which psychosocial factors are weighed, but they do sometimes increase the risk of not having as healthy a baby or as healthy a mom. More than an episiotomy would.

Or an epidural. Epidurals are associated with maternal fever, especially longer lasting epidurals, such as those associated with inductions. If a mom’s membranes break, or more likely, are artificially ruptured during active management of labor or an induction, and she subsequently develops a fever, many practitioners will consider that to be an indication for cesarean section.

Group B Strep is present in up to 40% of healthy women – a cesarean is not the recommended intervention for prevention of transmission of group B strep to a baby. The current standard of care is to administer antibiotics during labor.

As for the VBAC vs. elective repeat cesarean issue – it is obviously a highly personal choice, and one I am happy you were able to make without apparent pressure from your hospital system or your chosen practitioner. Please don’t present VBAC as higher risk, however. The larger risks of an emergency situation are very, very uncommon in a VBAC. In fact, they are identical to the risk of perinatal mortality in a primary vaginal delivery. There is a definite imbalance of risks to the mother (increased risk of hemorrhage, need for transfusion, and infection, as illustrated by your anecdotal experience) with a cesarean, and increased risk of neonatal trauma or morbidity with a VBAC. But, these risks are vanishingly small. One set of risks is not large and uncontrolled and scary, compared to one set being small and manageable and acceptable.

Anyway, I wish you a safe and uneventful birth, regardless of your chosen method of delivery. I am always happy when this site steps out of the zone of reproductive choice just being about preventing birth. And, you were very brave to put your personal decision our there. Just, please remember that when you are writing for a site such as RH Reality Check, a little reality checking may be in order.

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I’m in print!! *link fixed*

I have an article published in the Journal of Perinatal Education:

Social Media, Power, and the Future of VBAC

Squee!!!!

Special thanks to Amy Romano, who was the lead author and did almost all of the final version of the piece, and to Desirre Andrews, who was the other co-author.

Edited to add: I fixed the link, but now they are asking for pay-per-view. I think if you register for a free trial of Ingenta you can read it for free. If not, let me know.

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