ICAN says that it’s the international month of cesarean awareness and lots of other bloggers are talking about it. I’m not sure why this doesn’t seem to have reached South Australia but maybe I’ve just taken my eye off the ball. I’m always happy to review myself so I thought I’d enter into the spirit of giving women great information about VBAC.

Cost-Effectiveness of Elective Cesarean Delivery After One Prior Low Transverse Cesarean

WILLIAM A. GROBMAN, MD, ALAN M. PEACEMAN, MD and MICHAEL L. SOCOL, MD. From the Section of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago,Illinois. Address reprint requests to: William A. Grobman, MD Northwestern Memorial Hospital 333 East Superior Street, Suite 410 Chicago, IL 60640

Abstract

Objective: This analysis was undertaken to better understand the costs and health consequences of a trial of labor after cesarean when compared with a policy of routine elective repeat cesarean delivery.

Methods: A decision-tree model incorporating a Markov analysis was used to examine the reproductive life of a hypothetical cohort of 100,000 pregnant women whose only prior pregnancy was delivered through a low transverse cesarean incision. Using this model, the policy of performing routine elective cesarean delivery was compared with a policy of allowing a trial of labor. Main outcome measures were maternal and neonatal morbidity and mortality, total costs to the health care system, and cost per major neonatal complication avoided (death or permanent neurologic sequelae).

Results: The consequences of routine elective cesarean delivery for a second birth are significant, with an additional 117,748 cesarean deliveries, 5500 maternal morbid events, and $179 million incurred during the reproductive life of 100,000 women. The prevention of one major adverse neonatal outcome requires 1591 cesarean deliveries and $2.4 million. Sensitivity analysis confirms the robustness of the analysis.

Conclusion: Routine elective Cesarean for a second delivery for women with a prior low transverse cesarean incision results in an excess of maternal morbidity and mortality and a high cost to the medical system. find out more

Recovering after Cesarean birth of first child

A caesarean section is major surgery and with 1 in 3 women in Australia going under the knife it’s time the government paid more than just lip service to this and started to look at why.

62% of first time mothers who had an induction in this state ended up a section. Why women are timed out of birth with no problem with mother or baby and why Obstetricians schedules and private lives are more important than their clients birth. Really, until they start dealing directly with this VBAC is always going to be an issue for birthing women. (declaration here that we know that for about 5 to 10% of population will potentially need this to save themselves or their baby. I in no way think that they shouldn’t be available for emergencies. Thank god Obs are specialist surgeons as I wouldn’t want a midwife to section me!!)

So why do women chose not to have a normal birth after a Caesarean? Ultimately for a woman who felt no control over her previous birth it is a way of taking it back. These woman are never faced with the fact that mortality and morbidity are much higher with a Caesarean so they feel the choice is safer. The spin put on this by the medical system and backed up by many midwives lead woman to a decision which potentially puts their and their baby’s life at risk and nobody is shouting the fact from the roof top because a scheduled operation is a time management dream.

There isn’t any evidence to support the notion that it is dangerous and unsafe. The figures vary somewhat in the rate of VBAC but highest is 1% and the quoted norm seems to be 0.4% so you have at least a 99.6% chance of not encountering a problem with your uterus. If you look at all figure ratios for birth this is the very least of any issue you may encounter.

Glorious HBAC with second child

Entering into the hospital system with a birth after Caesarean changes your chance of birth to 17% even if you go there with all intention of a normal birth. The policy surrounding your ability to keep active has been taken away unless you plan on a big fight. Continuous monitoring which is mandatory is the biggest inhibitor to an active labour and with no evidence of it’s benefit you have given your baby a 2% chance of a misdiagnosis of fetal distress. Can you refuse, of course you can. Good luck with it though.

So after your section following a failed induction, you can’t have an induction due to the major increase in you risks of rupture, so can you wait? Did they let you wait when you didn’t have a scar on your uterus?

You had a very long labour last time and a section for failure to progress. This time you are limited more by a time figure that is pulled out of thin air by your Ob. Enough time for you to feel like they’ve given you a go but not enough time to realistically get your baby out unless you are very lucky.

Most popular diagnosis for section is CPD cephalopelvic disproportion. Now there are mainly 2 reasons for this, a disease of nutrition like rickets that causes a pelvic abnormality and a pelvic injury. Having birthed at home with a woman after 2 sections who’s baby was over 10 lbs which is 2lbs bigger than either of the sectioned babies, I say that absolutely it is possible after this blanket diagnosis to birth normally.

HBAC in March 2007

For women considering VBAC, it is important to look carefully at any care provider and see what it is they offer. Ask the questions that are difficult but are important to know before you decide where your best chance of birthing is. All the questions you didn’t ask last time but wish you had.

Getting your notes from the hospital can often be a help to actually find out what led to your last birth outcome to work out what to change and be clear about happened. You can do this through the freedom of information act. It is of benefit to go though them with someone independent who can see issues where you may feel vague about what was going on.

Look at all the information, facts, figures and questions and then make a good informed choice.

Joyous birth have excellent information for sufferers of birth trauma.

Cares SA provides information and support in South Australia.

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1. Blaming Women
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3. Caesarean Babies More Likely To Die
4. VBAC Information Evening
5. Induction Of Labour