Recent Posts

Friday, July 31, 2009

Birth Day: A Televised VBAC

This morning I was watching tv at my inlaws - they have fancy cable with all the premium channels I don't get at home. While flipping through I spotted a half-hour show on Discovery Health about VBACs and froze in my remote-controlled tracks. What?! They're showing a VBAC on tv? Skeptically, I thought it was going to end in the obvious way: mom would be scared into giving up her hopes of delivering vaginally and would be wheeled into the OR, pronto. I was pleasantly surprised to hear that the laboring mom had already had a successful VBAC and was now having her third child. Of course, doctors gave her the familiar warnings that her uterus could rupture, baby could die, blah blah blah. Not discounting that those things can happen, I'm sure she's heard it before, seeing as how she's already done it once. Granted, it was a half-hour show, so they could really only go over the major points: who should have them, who might not be good candidates, etc. etc. Her reason for a prior c/s was fetal distress, which is definitely a legitimate reason, but sometimes can be misinterpreted by a particularly overzealous doctor who is ready and waiting to slice you open. Halfway through mom's labor, an OB resident became concerned that the uterus was rupturing, as the baby's heart rate was starting to show decelerations. The patient's doctor came in, examined her, and thankfully determined that she could proceed and that the baby was probably fine. The baby was successfully born via VBAC, but was very blue. The minute they showed his little head coming out, I thought, Oh my God, he's blue, and was lifeless and limp as they moved him over to the warming table to clean him up. They would have to pick this particular birth to show a VBAC, I thought, meaning that whoever seeing it that might actually be considering one is probably sufficiently scared off from ever attempting it now that they've seen this episode. But something else struck a familiar cord in me as I watched this child enter the world: his cord was wrapped around his neck, just as my son's was. I sobbed as I held my baby and watched this show, not only for this fellow VBAC "sister," but also for what could have been in my own situation: I knew my VBAC was unsuccessful for a reason. While this woman's baby ultimately was fine, a healthy pink color and breathing on his own, I wondered if perhaps it would have been different for us. I try not to dwell on it too much, because, after all, I look at my chubby, healthy son and praise the Lord that he arrived safely. There are some points I wished the program would have touched on, though.
  • Many doctors will give you the option, yet do everything in their power to dissaude you from choosing it, including the use of scare tactics and even harrassment.
  • Your chances of a successful subsequent VBAC increase with each prior VBAC you've had.
  • The overuse and even abuse of Pitocin (which has often been called "the devil's drug" in some medical circles) and how studies show that the chance of uterine rupture, although rare, was increased in those women who had Pitocin during their labors. The risks further increased with the use of prostaglandins such as Cervidil, which are used to ripen the cervix.*
This last point is the scariest, because it might actually (well, you would hope, anyway) force doctors to re-examine how they 'manage' labor. I found an article dating from 2001 that discussed how the increased risk of u/r might turn patients off from the idea of having a VBAC, but yet goes on to say how the risks increase because of the use of Pitocin and similar labor-inducing agents. Which begs the question: When are doctors going to admit they can't control all aspects of the birth process, and change their practices accordingly? (Even though the article is almost a decade old, the same ideas and mentality are still very much at work here.) Sadly, probably never. It's too much of an industry for some, which turns the birth process into little more than a baby-making assembly line where all laboring moms should fit the same model or want the same thing from their births; the idea that 'it doesn't matter how you got here, just as long as you did.' After awhile the "you" part of this equation starts to feel like you have very little involvement in the whole process and are just a vessel, prodded and poked and insulted like you're a piece of flesh that has no feelings whatsoever. The following phrase comes to mind: "Doctors will get down from their pedestals when patients get off of their knees." *It's important to note that some doctors, even against dire warnings to do so, will still induce labor with the synthetic prostaglandin Cytotec. Its off-label use for induction of labor can cause miscarriage, severe birth defects and uterine rupture even in women who have had no prior uterine scar. Doctors will sometimes use it because it's supposedly cheaper than Pitocin, and claim that it's just as safe to use. I'm not sure how many doctors are still using this drug, but if yours is one of them, please know the risks and then run the other way. Searle, the drug's manufacturer, has issued numerous warnings against its use in labor inductions, and personally I think doctors who ignore those warnings are throwing all common sense and caution out the window in favor of the all-mighty dollar.


sara said...

my doctor mentioned that she uses cytotec at one of our prenatals, and dismissed all the documented side effects as baseless! I switched providers at 39 weeks after I heard that!