VBAC Frustrations

It has a lot to do with the hospital they have access to. From what I was told by an OBGYN friend of mine; if the hospital has a roving anesthesiologist, they won't do VBAC, but if the labor and delivery ward has a dedicated anesthesiologist, they will. No Dr. (and no patient for that matter) wants to deal with a crash C-section. My husband witnesses a crash C-section in residency once and said it was truly one of the worst things he ever saw.

It's a liability issue. My doctor's office won't consider it, but they'll refer you to doctors in the area that will.

It depends on WHY you had to have the c-section, how long it's been and what your scar healing is like.

So - if you had to have an un-planned c-section because your baby was 15 pounds, but that was 10 years ago and your scar is barely noticable.... that's MUCH less risk than having to have a c-section because you had uterus issues and it was 14 months ago with a scar that is still red.

See?

So - WHY did you have one and how long has it been?

It also depends on the hospital setup. Most people will tell you that the rumor is that your uterus might burst but that's just urban legend and nobody knows anyone who actually had their uterus burst during a vbac.
Well *I* DO know someone. My ex SIL - tried a vbac with her 3rd kid. She had to have a c-section with her first, had diabetes with her 2nd (4 years later) and she did vbac - fine. With her 3rd kid (2 years later) her Dr was wary...... because your uterine muscles get weaker with each kid. Thank God she was in a hospital that could do a c-section right in the delivery room (not in a different OR) because when her uterus ruptured she had to have emergency c-section and they said if they would have had to move floors she might have bled out. She had to have several transfusions and an additional surgery.

So- you have to look at EVERYTHING - what is the set up of the delivery room? Why did you need the c-section etc.

Usually, the hospital dictates whether or not they will allow VBACs. A doctor doing a VBAC has to be at the hospital the entire time the woman is in labor. There aren't many doctors who are willing to sit at the hospital for 30 hours while a woman labors -- if they were willing to do that, they'd be doulas ;-)

So your best bet is a teaching hospital where there is *a doctor* on duty all the time -- not necessarily *your* doctor. Kaiser hospitals and most teaching hospitals allow them. It's not the doctor's fault or choice!

Also, uterine rupture is not much of an issue. It does happen, but it's very, very rare. I've attended the births of 520 babies and have only seen one uterine rupture ... and she wasn't having a VBAC!

Happy Birthing!

T. H.
bestdoulas.com

have you looked for a midwife?

S. -

It is hard to find a doctor who will do a VBAC because of hospital policies, insurance liability and frankly, there are lots of doctors who find it easier and more lucrative to schedule a c-section. You won't get woken up in the middle of the night with a scheduled c-section and you won't have spend hours in the hospital with a VBAC patient in labor. The only reason to accept VBAC patients is to abide by the Hippocratic Oath:)

Please, please contact your local ICAN chapter - http://ican-online.org/chapter/search I don't know where Azusa, CA is but even if you don't have a local chapter - reach out to the ICAN community via email and I am sure that you will find local resources.

Please feel free to send me any questions directly. I have been an ICAN chapter leader, had a c-section and then had a CBAC (planned a VBAC birth but ended up with a cesarean).

You sound like a perfect candidate for a VBAC!

Cheers,
C.

ICAN is a great resource. You may be able to find a provider through their website that accepts your insurance.

I was supposed to have a VBAC with my second. My OB said I was a good candidate. Even though there were risks, she'd never been the presiding doc at a uterine rupture.

Well, my second was a week late = no VBAC. Good thing because my scar tissue from the last c-section was thin and the newborn had a big head (neither situation good for VBAC). In the end, it was a good thing I had to have a second c-section, even though my OB was totally willing to try for VBAC.

The next week, my OB had to deal with a uterine rupture during a VBAC. They do happen, but they are rare.

If my OB were totally avoiding doing a VBAC (and some completely refuse to do them), I'd try to see if I could find another doctor more willing to try. But make sure you are in a very good hospital where surgery could happen immediately if anything bad happens.

Good luck!

I know 3 people that have uterine ruptures after vbacs !! One had massive blood transfusions, & one had an emergency hysterectomy !! I also have two close friends that had VBACs without a single complication!

It's not just an insurance thing. Doctors as a whole don't want to take a chance of losing a mother or baby. You are high risk and will have to find a high risk doctor. Your original doctor is in the minority of OB's who are willing to take the risk.

I had a VBAC (same as you...1st vag, 2nd c-sec, 3rd VBAC). My doctor ONLY entertained the idea because he did the c-section. That may be the problem. Good Luck! Also, what was the reason for your c-section? Could that possibly be the issue?

I'm assuming it is a insurance thing. My VBAC was 14 years ago but I made a deal with my OB saying that I could attempt the vbac but if things went bad that he was in charge and the ultimate goal was a healthy baby and for me to be safe. So when I checked in to the hospital, I had a IV inserted, but it wasn't hooked into anything.

I would look to see if there is a ICAN or a La Leche League in your neighborhood. They might help.

Good luck!

Also check whether your insurance has any Certified Nurse Midwives as OB providers. I had a CMN with my daughter and delivered with her in a hospital. These days many hospitals have midwife practices attached.
They are often much more open to VBAC and since they deliver in a hospital you have access to all of the emergency services you would have with an OB (including pain medication and surgery if needed).

Also get a letter/note and your record from the old doc to take to the new provider. That may help make your case.

And thirdly, yes it is just a cover your a$$ issue. Also because VBAC's have been so rare many doctors are not well educated on managing them...

Good luck.

Wow....I feel really bad for you because my best friend had a C-section with her first son as he was a fairly big baby and was also breech right up until the very end. Her second child was a girl and she had a successful VBAC with no problems and no complications at all. My mother is a physician and what she has told me over the years is that because of all the litigation out there and people looking to sue every doctor on the planet, medical professionals are seriously held back with what they will and will not attempt to do. Most have the skill and the experience to accomplish many difficult or more intricate procedures and between the threat of getting sued and the cost of medical malpractice suits, it discourages doctors to excel and reach for their personal best. Keep searching and interviewing OB/GYN's in your area or maybe in the surrounding areas that are near you. A major metropolitan location that has a teaching hospital will be your best bet. That's where the medical rockstars are going to be and also their mentors and skilled educators. I really hope you get your way here. Unless there is a viable medical reason in regards to why you are not a good candidate for VBAC, then this is simply doctors running scared and insurance companies controlling them all the way to the bank. UGHHHHHH! Let us know how it goes.

Call you new insurance provider and INSIST that they consider your doctor an "in network" doctor since you are mid pregnancy. I know many people who have had to fight for this but are successful. Good luck! Don't stop fighting and get his company HR and benefits broker involved.

Yes, it's an insurance and liability thing. The malpractice insurance for practices and hospitals accepting VBACs are much higher.

You could go the midwife/birthing center route, but you'd have to pay out of pocket. Still, the out of pocket costs can sometimes be less then what insurance doesn't have to pay at the hospital.