Planned C-section turned unplanned HBA3C (home-birth after 3 Cesareans)

How’s that for a story? Oh, and it happened only about an hour away from where I live! Here’s the article, from the Memphis Commercial Appeal. She was supposed to show up for her fourth C-section on Dec. 6. Instead, she started having contractions on Friday the 13th. (Actually, she says in retrospect, she had started labor in the night, but they were so mild, she didn’t recognize them as true contractions.) Then her water broke, and in a couple of minutes, the baby came out, “caught” by her two-year-old son! [The three-year-old was a little freaked out. {Shrug}]

One odd thing, is that she related that the contractions for this labor were not as strong as those with her other children… but if they were all born by C-section, I’m wondering why. I can see her having a normal labor for the first one (most likely induced and/or augmented with Pitocin), and ending in an unplanned C-section. And I can see them allowing her to attempt a VBAC with the second, but usually not with the third — although it’s possible she showed up in labor and was given a C-section. Oh, the details these stories written for the general public leave out!

Another woman proves her body works, and her vagina is actually useful in birth. 🙂

h/t Birth Activist

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That’s a lot of C-sections!

I recently found this article on a women’s website a friend recommended to me, and just had to share it. Wow. A woman had all of her children by Cesarean — seven total surgeries! And it mentions another doctor who performed thirteen C-sections on one woman back in the 1970s. Incredible!

However, I will point out, that statistically, the risk of adverse complications (both during the C-section and in a subsequent pregnancy) do increase with every C-section, sometimes exponentially. So, if you can avoid a C-section in the first place, or have a vaginal birth after Cesarean, that’s going to be better for you and any future babies. I don’t know if these grand multip C-section moms have been studied to see what the rate of adverse events (like hysterectomy, hemorrhage, hemorrhage requiring hysterectomy, future placenta previa/percreta/acreta, etc.) are. There probably aren’t enough of them to do anything but case studies.

Still, that was incredible to me. I honestly would have assumed that the rate of complications would have been so high that most women would have ended up with a hysterectomy or chosen to have their tubes tied (or been coerced into it, as was attempted for this mother, or even sterilizing her without her consent) , or in some other way just stopped having babies. I was wrong. I’m not sure if these women are “beating the odds” necessarily. As long as the rate of X is below 50%, then odds are that they will not have X problem. But, the odds of a hysterectomy or hemorrhage or any of these other bad things with a VBAC is much lower than with a repeat C-section — especially when you get into higher numbers of C-section.

I would assume that the mother from the 1970s would have had a classical or vertical incision, which is contraindicated for VBAC attempt (although I know a woman by email who did have a VBAC after a classical C-section, and the labor was induced or augmented with Pitocin, which adds another layer of contraindication; but her uterus did just fine), so she may have been a poor VBAC candidate (especially at a time when “once a C-section, always a C-section” was the rule of the day). But there is no indication why the other mother had any of her C-sections, either the first, or any of her repeats.

Interesting. Very interesting.

~*~

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“A decision made out of fear is no decision at all”

I recently received the following comment, in response to a past post about multiple Cesareans. It provided much food for thought, so I wanted to share it so all my readers could see it.

I really appreciate this site and its boldness for spreading truth.

I have had 6 unnecessary c-sections. They have all been low-transverse and healed well. My first was due to malposition which could have easily been changed if I would have been “allowed” to move. I was dilated and effaced completely with no induction. My 2nd c-section was due to the nurse “accidentally” rupturing my membranes when I was only dilated to 7 and the baby not coming right away. How stupid of me to allow them to cut me again and not just wait. I had this baby over four years after my first. There was no reason at all to operate. My doctor was distressed!

My 3rd c-section was about 2 years later and was elective due to scare tactics. With my fourth pregnancy I was much more educated in the field of child birth and VBAC and was completely prepared to have this baby naturally. Everything went great until I went to the hospital. I was treated like a criminal preparing to commit murder. I dilated to 10 on my own, but was still harassed and harassed until finally forced to have a c-section. During this operation my fascia was not put back together and I had a bulge the size of a small water balloon below my navel. I still suffer from this operation that was performed over 8 years ago. My 5th c-section was performed after finding a doctor who I felt supported me. I dilated again to 10. The baby was even descending into the birth canal. I had a nurse that was extremely nervous and told me I was taking too great of a risk. She frightened the dr and he demanded that I have another c-section. During this c-section the doctor nicked the main artery that connects my left fallopian tube to my uterus. I almost died from blood loss in this operation. I needed at least 2 or more transfusions and I had to spend the entire night in the ICU without my baby boy. It was horrible!!! That was considered the “safe” option….a c-section! My 6th c-section was in April 07. It was planned and I had a wonderful birthing experience. The doctor treated me human and cared very much for me. He told me that my uterus looked great and I was ready for baby #7. He knew we wanted a big family. That was in Germany.

So, here I am now…I am in TN. I am almost 30 weeks pregnant and still have not even seen a OBGYN. This is the first time I feel very frightened about the medical system. I have been in contact with a Dr. via phone and email. She is a Dr/Midwife and we are seriously considering a Home birth. This is where I am now thanks to the abuse I have received in the hospitals. I am a woman wanting to have a baby. I want to be treated like a human not like an atomic bomb waiting to go off. I have read and read and read both sides…I know the risks. I am concerned about the safe delivery of my baby. But I have been frightened away from medical staff…There is so much more to my story. But, it would be too long to write here. I have been abused emotionally and physically. I feel I have been violated and have lost my body to a system…an evil system that believes that having a baby is a medical condition. Having a baby is not a medical condition. It is a normal, natural, God-given process that man has perverted and taken control over. Allow woman to just have their baby in a peaceful and safe environment. Leave us alone! If there is an emergency, we are thankful to have the medical staff…but until then, please let us be and let us give birth! The doctor does not need an enema every time he has to use the rest room and women do not need any interventions or inductions to have their babies!!!!!

Sincerely,

A woman who just wants to give birth not have an operation,
Angela
PS. A decision made out of fear is no decision at all!!!!!

How’s *this* for a consent form?

From a p*$$ed off mama denied a VBAC — priceless!

h/t to Maternal Instincts for the link

Educated Birth

This is a video which was made for the Birth Matters Virginia Contest. It’s not my video, but I liked it. (I’m sure there are many other videos made for this contest, so you can probably do a YouTube tag search and find them. If I have time, I’ll try to remember to do this myself.) Because it’s in the contest, please make sure to rate it!

Thanks to Diana for the link!

VBAC Bibliography

April is Cesarean Awareness Month, and a lot of bloggers have been posting a lot of C-section related stuff (more so than usual), and here is a wealth of information on VBAC — nearly 100 links or other sources. Wow. Enjoy (or not as the case may be, since some of the links look sad just by the title).

Hmmm….

Recently, I wrote about the increased risk of placenta accreta or percreta due to a previous C-section. While the risk of placenta problems definitely increases exponentially for every previous Cesarean, there was something in the article that bugged me:

Studies and textbooks suggest that the risk of developing an accreta is as high as 40 percent in women who have had two previous Caesareans; that jumps to 60 percent with three C-sections, their physicians said.

Although I’m a strong proponent of vaginal birth, I do want to be truthful about C-sections, and I don’t think the above sentence is accurate. It just seems too high. Running some numbers — there are about 4 million births per year, and about 30% of them are C-section. I think that approximately 40% of annual C-sections are first-time sections, while the remaining 60% are repeat sections, or about 720,000. I haven’t looked it up, but I would hazard a guess that of the repeat surgical births, half of them are a second C-section, while the remainder would be a third or higher C-section. If the risk of accreta really were 40% after a second C-section, that would mean that 144,000 women would be at risk every year of developing placenta accreta. I just don’t think it’s that high. That would be 3.6% of all pregnant women developing accreta, or 36/1000. The article quotes current rates of accreta as ranging from 1/500-1/2,500 births, or 0.002-0.0004 — 18-90 times less than .036. So, even if some of my hypothetical numbers are wrong, there’s still plenty of wiggle room between “40-60% risk of developing placenta accreta” and 1/500-1/2,500.

Probably what happened is the reporter got confused, and misunderstood some of the literature. In trying to get to the bottom of this — to see if the risk of developing placenta accreta or percreta was really as high as the article quoted — I saw that there were numerous times when the phrase “placenta accreta/previa” was used. The gist of the articles and studies I read, was that when a woman has placenta previa (the placenta grows over the opening of the uterus — which is also more likely to happen after a prior Cesarean), then her risk of also developing placenta accreta is very high — along the lines of the percentages given in the quote. But if a woman does not have placenta previa, then her risk for placenta accreta — while it does increase exponentially with every C-section — does remain fairly low, and nowhere near the 40-60% risk solely due to past C-sections.

Another possible misunderstanding the author may have had was along these lines — finding that women who had accreta or percreta were much more likely to have had C-sections (which is very true), and getting the percentages or risks for that confused with the risks for developing accreta or percreta to start with. While I don’t know if this was the case, I have read many things (not just birth-related) in which journalists screwed up in a similar fashion. I’ll give you an exaggerated example of how easy it is to confuse matters, if you didn’t know any better:

Let’s say that about 86% of all women who choose home birth in the United States are both white and married. A journalist could easily get a bit muddled and report that in the United States, 86% of white, married women give birth at home. Since you and I are knowledgeable and educated birth junkies, we know that only about 1% of all births in America take place out of the hospital, so we would never be taken in by this misstatement. But others might. The two statements are very similar — an accurate percentage is given, and the details (home birth, white, married, United States, women) are all the same. But you can see the obvious difference between the two statements.

I should have caught the problem before I wrote my previous post; but since I didn’t, I wanted to clarify.