Key points that Dr. Fischbein makes include the importance of knowing the risks and benefits of VBAC and how much risk you're willing to accept. After all, he says, getting out of bed in the morning is riskier than staying in bed, but we're all perfectly willing to accept that risk and go on with our day. How is having a VBAC any different?
According to Dr. Fischbein, the risks of having repeat c/s over and over again - especially in the (rare) event that a couple wants to have a large family - can include thinning of the uterus, possible uterine rupture prior to labor in subsequent pregnancies, scarring, pain from adhesions, potential risk of increased blood loss and damage to the bladder, bowel obstruction, and the placenta growing into the uterine wall, which could lead to hysterectomy after the birth. Some of these risks, like blood loss, uterine thinning and rupture, bladder damage and adhesion pain can happen even after one or two c-sections, depending on the person. During my second section, my doctor apparently removed scar tissue that had built up after my first section five years prior. And maybe I'm crazy, but I think the pronounced discomfort I feel at certain times of the month is definitely scar adhesion pain.
But after all those possible risks, Dr. Fischbein makes one very interesting and important point: that "these risks are usually not mentioned to women. All you hear is that 'your uterus could rupture and your baby could die.'" I call this lying by omission - because if you haven't done your research and believe everything your doctor is (or isn't) telling you, then your choice has really been made for you. Which is unfortunate.
The biggest obstacles for pregnant women are their doctors - whether unintentionally or intentionally - misinforming them or omitting important facts about the risks and benefits; other women who have a negative story about this that and the other that often discourages women from even wanting to attempt a VBAC; and themselves. Yes, sometimes we are our own worst enemies - because we don't act enough as our own advocates and find out every detail and kernel of information that could weigh in our favor against this medical professional we practically see as God. After all, he/she was the one who went to med school, right? They know way more about my body than I do, right?
Dr. Fischbein notes that it's unfair to women to get skewed counseling from their doctors based on lies and misinformation. He does say that ACOG (The American College of Obstetricians and Gynecologists) still supports VBAC in their literature, but I'm willing to bet that if any doctor has that pamphlet in his office, it's probably carefully hidden or sitting at the bottom of a trash can.
One take-home point worthy of remembering: "The choice ultimately belongs to the patient herself." Dr. Fischbein, you rock.