I went in at 10:30, and Rianna was pretty uncomfortable.  She is the mother of twin boys, 11years old, delivered by c-section, and a girl, 9 years old, delivered vaginally.  She was planning to have a natural birth with this set of twins.

    When she was checked soon after my arrival she was at 4 cm dilated, and 100% effaced.  She was lying on her side, and pretty uncomfortable.  I pressed on her back , which helped a little, but she complained of back pain.  I got her to sit on the ball, on hands and knees, in the rocking chair, standing, swaying, circling, and within an hour, while on the toilet, she was starting to feel some pressure.  She was 7cm, and stayed there for a couple of hours, now consistantly asking for pain medication.   Things were incredibly intense, especially the pain in her back. The rocking chair and Nubain helped her to relax for a little while, but she decided she wanted an epidural. 

    The anasthesiologists were busy, and her epidural had not yet arrived by 3:00, when they wheeled her into the operating room to deliver her twin boys.  She was at eight cm, and stretchy, opening quickly to 10 and complete.  There were three doctors there, and at least four others, including nurses.   When one of the doctors entered the room, she dimmed the lights and put on music.  What a nice touch that was, softening the sterile environment.  Rianna was determined and strong and had that first baby boy out in about 20 minutes, and the next 16 minutes later.  

    It was incredible to witness, and completely normal, safe and healthy.  The babies were snuggling on their mama'a breasts when I left, while she and the doctor and nurse juggled them onto her nipples.  Amazing work, nursing two at a time!

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 VBAC is an incredibly political topic in the birth world.  Doctors in the United States are telling women who have previously had ceasarean section births that baby number two will have to be born the same way.  The driving factor in this situation is medical  malpractice insurance companies, who are faced with a growing number of  lawsuits from people claiming that an emergency ceasarean was not available quickly enough.

  One of the effects of the rise in malpractice suits, is that these insurance companies are targeting a procedure that research shows is reasonable and safe.  Many insurance companies are instituting strict standards of procedure for planned VBAC births, which can cost hospitals thousands more dollars to provide.  Many companies are excluding coverage altogether for doctors to allow women with a history of C-Section to attempt a Trial of Labor (TOL). If the doctors and hospital have no insurance coverage, they will not allow the procedure.

What are the risks of a ceasarean section?

Risks of this major abdominal surgery include hemorrhage, bowel obstruction, pain, infection, and tissue scarring and adhesions.  Bonding and nursing are challenged, and babies are more likely to be cut, born early, have breathing problems or weigh less.

What are the risks of VBAC?

Research shows that less than 1% of VBAC births result in uterine rupture  (1.6 per thousand.)  These studies have  included women whose labors were induced.  Pitocin and cytotec, labor induction and augmentation drugs,  create artificially strong contractions, so it is likely that  a study done with women experiencing spontaneous labor would have even lower chances of uterine rupture occuring.   Cytotec is not used any longer in cases of previous ceasarean, and pitocin is monitered closely to keep the dose under control. The risks  of the scar giving way were also greater when incisions were made vertically and higher, but the way the incision is made now, low and vertical, has much better results. 

Vaginal birth itself has a greater risk of continuing perineal pain or incontinence, and a greater risk of baby suffering nerve damage in the shoulder area.

This is a topic that women need to continue doing their research about, as doctors may just tell them that a repeat ceasarean is the best option.  Ceasarean section can be a life saving operation, if necessary, but the c-section rate in America is almost 30%.   Many healthy women are facing unnecessary risks from this major abdominal surgery.  90% of women who have had previous ceasareans are having repeat surgeries.  It is clear that ceasarean section has complications and risks, and the research leans toward those risks outweighing the risk of VBAC.

more online resources:

http://childbirthconnection.org/article.asp?ck=10166#systematic
VBAC research statistics

http://pregnancychildbirth.suite101.com/article.cfm/vbac_controversy
risks of c-section

http://www.mayoclinic.com/health/vbac/VB99999/PAGE=VB00009
The Mayo Clinic reports that VBAC is safer

http://findarticles.com/p/articles/mi_m0CYD/is_3_40/ai_n11832004/
insurance companies set standards for VBAC procedures

http://pregnancy.about.com/od/vbac/a/deniedvbac.htm
What to do if you are denied access to medical care for a VBAC

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