Because just everyone is dying to know....
I hate and despise VBACs (vaginal birth after cesarean). I suspect it all stems from an experience early on in my career. This was back when the swinging pendulum of expert opinion had swung to the side that encouraged women to attempt a VBAC. I was working at a very busy facility where prenatal care was unusual - so unusual, in fact that even if you had prenatal records we never even looked at them. The c-section rate was so far over 50 that we had stopped caring or counting. So, needless to say the majority of women who came in in labor had had a previous c-section. In such cases the Obstetricians allowed them to labor normally if they chose.
One day a woman came in, in labor with her second child. She was young and in love, excited and wanting to deliver vaginally. Upon request she got an epidural and went on to deliver a beautiful baby girl. She was then moved to the recovery room where she began to bleed excessively. The Recovery Room Nurse had called the Obstetrician to come and see the woman immediately. Although he arrived within moments, the patient was already becoming incoherent. I watched, inexperienced from the sidelines. I don't remember all of the details... just a whirl of activity, lots of people, desperation, so much blood... and then they transferred the patient to the ICU. When I came in to work the next day, the first thing I did was ask about the patient. She had died because of a ruptured uterus.
Today when another woman came to our unit with the same situation, I thought of that patient so long ago. I know I'll never forget her. When she comes to mind I remember how happy and excited she was to deliver naturally. I wonder about her young husband and their baby daughter. How does a little girl grow up without a Mother? And all because you want to deliver vaginally. Really??? Is feeling a baby come through your vagina so freaking important? Really, people??? Are you really willing to risk your life and the life of your baby because that is so important?!
I don't know what the rate of rupture is today. It changes somewhat with research. Does it really matter? Whether it's 1% or 10% that means a Mother and/or a baby can die. DIE. It happens. I've seen it. There's no coming back from that.
2 comments:
No, having a baby come out of my vagina is not that important.
Not having repeated major surgery, however, is.
BTW, the risk of UR with a single lower transverse incision is less than 0.5%.
The level of risk matters. There is no risk free birth; it's all about what level of risk you are willing to take on. The minute you get pregnant, you are risking your own life.
I feel your pain. I feel that way about Macrosomic babies. Only because I had an ugly, ugly shoulder dystocia in my career which caused the Doctor to retire. So now every shoulder dytocia I worry more than the average bear.
But what did this woman you are speaking of die of? And will more women die because of c-sections? I think more will die because of c-sections. Not enough for you or I to notice because maternal death is still so rare. All the women I have seen expire in labor were amniotic fluid embolism and DIC.
However, number matter very little when it is your patient on the table who is bleeding out. So hey I respect your given right to not like vbacs. YOu never have to change your mind. I respect your decision. Let some other nurse do the Vbac. I am sure there is one somewhere around. I know I try to avoid macrosomic diabetics.
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