Medical Malpractice

Pronounced Vee-back -- Vaginal Birth After Cesarean - When a woman has a cesarean section with one baby and then has a subsequent baby vaginally. It sounds simple enough, doesn't it? Not in this political and medical climate, it is not.

Forty years ago, the rule was "Once a cesarean, always a cesarean." In the 1980's, a swing occurred when obstetricians (OB -- doctors who specialize in pregnancy and childbirth) began supporting VBAC. Now, the pendulum is swinging (many believe has swung) the other way with the latest statistics showing the cesarean rate in the U.S. is 31%. Considering the World Health Organization says the cesarean rate should be no greater than 15%, our 31% is atrocious.

Women desiring a VBAC might have to look long and hard to find a provider to attend to their birth. In many places around the country every hospital and every doctor in the area refuse to do a Trial of Labor (TOL) that would lead to a VBAC if successful. Many factors contribute to this refusal including administrative requirements that an OB and anesthesiologist be in-house as a VBAC woman labors. This can be cost prohibited for doctors as it would not allow them to do office hours or spend any time with their families. Another reason for not doing VBACs is the doctor's malpractice insurance not allowing them; they feel they are simply too risky.

What are the risks of a VBAC? A very small percentage of women will have a uterine rupture is 0.8%. Women who have a rupture of their uterus can have catastrophic consequences such as the baby dying as the mother hemorrhages. Very, very rarely, a mother can bleed to death from the opening of the uterus. However, when the person is you, the risk is 100%. This is why some doctors refuse to do VBACs.

It is recommended that VBACs not be induced (using either prostaglandins or Pitocin) as this seems to cause many of the uterine ruptures. An epidural is not seen as a cause of a rupture, however, so women need not go without pain medication. But, supporters of VBACs highly encourage natural birth as the rupture can often be felt early enough to avoid the tragic consequences of a complete rupture.