VBAC

Donna wrote:

I can't speak to the scaremongering that Ericka mentions, other than to say
that that hasn't been my experience. My OBs used to encourage VBAC, but
over the last year their insurance carrier has refused to cover them for
this procedure, so they cannot offer them. My OB feels very strongly that
VBAC can be, in many situations, safer for the mother than a C-section, but
no longer has the option to offer this.

Ahhh, but it has been scaremongering that has caused
the insurance companies to refuse to cover (or has caused
hospitals to refuse to allow it, or has caused OBs to refuse
to back midwives who attend VBACs), and some doctors *have*
been advising women that the rupture risk is unacceptable.

I think some women prefer the devil they know and
have been scared off by the scare mongers.

Ummm... or perhaps some of us had good c-section experiences. That is a
possibility, of course.

Sure, didn't meant to downplay that. I was
thinking of both vaginal birth *and* surgical birth
having their own demons in people's minds.

Best wishes,
Ericka

"Wendy" wrote in message
...
Since I am very seriously considering a VBAC I have been reading up on
it and going to different websites for info. The stuff I have been
reading seems almost too optimistic. I read VBACs have a 85% success
rate and risk of rupture is less than 1%. Is this really true?

As Ericka said these are true numbers according to the research.

I asked
my doc at my last visit how many women have repeat c-sections and he
said around 80%. If VBACs are so successful and safe why aren't a
higher
percentage of women having them? I guess with my c-section experience
I
cannot imagine why anyone wouldn't want to avoid one like the plague.

For several of the reasons stated by others, malpractice insurance
companies refusing to cover providers leading to unsupportive doctors
and hospitals, mothers finding it easier to schedule particularly if
they have had a bad labor experience and others.

Any info, stories, or opinions on VBAC would be much appreciated.

I have had two VBACs following a c/s almost 8 years ago for breech
presentation with my first DD. My second DD was born via VBAC following
a long spontaneous labor 12 days past EDD that went on for over two days
and ended with slight shoulder dystocia after 40 minutes of pushing but
a very healthy, happy DD who is now 4. My DS was born 6 weeks ago via
VBAC as well. This labor was gently induced with pit after I developed
pre-eclampsia. Actual labor took around 8 hours and was more intense
than I remember it being last time but not the pit hell that others talk
about. There was also the stress of refusing a c/s and signing consent
forms because my hospital 15 days prior to my EDD began refusing to do
VBAC because of their insurance company. My doctors were very
supportive and felt that I was still a good candidate for VBAC.
Everything turned out great but only because of my determination to have
my VBAC. Someone less determined would most likely have just given in
and had the c/s. I will note that my c/s was scheduled due to
presentation and was not a horrible experience as some women have BUT I
was and still am determined to have VBACs with all future babies. I
think there will be one more yet as well.

Just as a humerous note, up to the time I delivered since the VBAC ban
was put in place, three women including myself had attempted VBAC and
all of us delivered vaginally. My hospital has NEVER had a case of
rupture with or without VBAC attempt so their fear seems a bit
irrational to me but then I am rather emotionally involved!

Good luck with your VBAC.

Cali
J. c/s for breech 8/14/96
E. VBAC 4/12/00
D. VBAC w/ induction for pre-e 5/26/04

"Ericka Kammerer" wrote in message
...
Donna wrote:

I can't speak to the scaremongering that Ericka mentions, other than to
say
that that hasn't been my experience. My OBs used to encourage VBAC, but
over the last year their insurance carrier has refused to cover them for
this procedure, so they cannot offer them. My OB feels very strongly
that
VBAC can be, in many situations, safer for the mother than a C-section,
but
no longer has the option to offer this.

Ahhh, but it has been scaremongering that has caused
the insurance companies to refuse to cover (or has caused
hospitals to refuse to allow it, or has caused OBs to refuse
to back midwives who attend VBACs), and some doctors *have*
been advising women that the rupture risk is unacceptable.

What I truly don't understand, is if the data supports VBAC as being a safe
procedure (which is my understanding), then *how* can the insurance
companies get away with refusing to cover physicians who perform it? I
don't know much about the inner workings of medical insurance works in the
US - Is anyone here in the inside, and can shed some light on that?

Sure, didn't meant to downplay that. I was
thinking of both vaginal birth *and* surgical birth
having their own demons in people's minds.

Yep, I can see that. They can both be pretty scary to contemplate until
you've been through it. Even afterwards.

(I'm perfectly comfortable with having a C this time, but I won't lie and
say that I'm not a little nervous contemplating it. )

Donna

Donna wrote:

What I truly don't understand, is if the data supports VBAC as being a safe
procedure (which is my understanding), then *how* can the insurance
companies get away with refusing to cover physicians who perform it?

There was a crappily done study that showed VBAC as
having a higher rupture risk that ERCS (though it showed that
the rupture rate without prostaglandin induction was no higher
than the rupture risk for a primip attempting a vaginal birth),
and shortly after it came out, insurance companies started
cracking down and hospitals started imposing rules about who
could VBAC and what resources had to be in place for VBAC and
so forth.
They don't have to base their recommendations on *good*
science. Insurance companies rarely base their coverage rules
on evidence based medicine. They base it on standard of care
(e.g., what everyone is doing, regardless of whether it's
supported) and cost/benefit analyses.

I
don't know much about the inner workings of medical insurance works in the
US - Is anyone here in the inside, and can shed some light on that?

First and foremost, most insurance companies are
owned and run by physicians ;-) After that, you usually
need look no further than a cost issue to explain their
behavior. I suspect ERCS is cheaper than VBAC, especially
with so many hospitals imposing rules requiring additional
resources for VBAC attempts.

Best wishes,
Ericka

Donna wrote:

What I truly don't understand, is if the data supports VBAC as being a safe
procedure (which is my understanding), then *how* can the insurance
companies get away with refusing to cover physicians who perform it? I

Insurance companies, like lawyers, work with the idea of *possibility*
rather than *probability* in mind.

"Ericka Kammerer" wrote in message
...

First and foremost, most insurance companies are
owned and run by physicians ;-)

Now this I would like some kind of supporting evidence for. It's nothing
I've ever heard. As a matter of fact, I can't think of anyone other than
personal injury lawyers that is more soundly loathed than medical insurers,
by the medical establishment.


After that, you usually
need look no further than a cost issue to explain their
behavior. I suspect ERCS is cheaper than VBAC, especially
with so many hospitals imposing rules requiring additional
resources for VBAC attempts.

Ericka, the big suspicion around here is that OBs love to do c-sections
because they make more money for the evil, money-grubbing physicians
(wink), when in fact, c-sections and vaginal delivery reimbursement rates
are, in the end, nearly identical. To argue that VBAC is discouraged
because it is perceived as more expensive is a) antithetical to the
commonly-held paranoia, and b) unlikely. Look, I know the environment here
is very distrustful of established Western medicine, but physicians are not,
as a group, out to screw the ignorant public out of every dime they can,
regardless of individual patient health and welfare.

Donna

Donna wrote:
"Ericka Kammerer" wrote in message
...

First and foremost, most insurance companies are
owned and run by physicians ;-)

Now this I would like some kind of supporting evidence for.

PLICO is *the* malpractice carrier in Oklahoma. It is a wholly owned
subsidiary of the Oklahoma State Medical Association, and their board of
directors are all MDs. (http://www.osmaonline.org click on OSMA
subsidiaries, then on Plico.)

Phoebe
--
yahoo address is unread; substitute mailbolt

Speaking of people who have good c-section experiences, my mom had one
vaginal birth and three c-sections and she swears they are the way to
go. All of her c-sections were very positive experiences for her. She
didn't have the complications I had, though. I was in horrible pain
afterwards, had a raging fever due to infection, and then had another
surgery 10 days later due to a lump of "scar tissue?" That could be a
post in itself. Sigh.....I don't want to do something unwise but I also
don't want to go through the misery of another c-section and I would
NEVER go through another 14 hours of pitocin hell. But maybe the next
c-section would't be so bad? Your replies have been very informative.

Wendy

Wendy says:

I read VBACs have a 85% success
rate and risk of rupture is less than 1%. Is this really true?

When I was reading up for my VBAC attempt, the success rates I had heard
were lower, more like 67-75% and as low as 50% depending on the cause of
the first cesarean. IIRC, 85% was the success rate for VBAC attempts that
followed a cesarean performed for breech presentation; the 50% success rate
was found for VBAC attempts that followed a cesarean performed for
malpresentation. In malpresentation, the mother may have been fully
dilated and pushed to no avail; in breech, the mother usually had a
scheduled cesarean and is therefore something of a primipara as concerns
laboring. As such, it's sort of the best-case scenario for VBACing.

The risk of rupture is less than 1% but is higher when Cytotec and other
induction drugs are used.

-- Alpha
mom to Eamon and Quinn

Donna wrote:

"Ericka Kammerer" wrote in message
...


First and foremost, most insurance companies are
owned and run by physicians ;-)

Now this I would like some kind of supporting evidence for. It's nothing
I've ever heard. As a matter of fact, I can't think of anyone other than
personal injury lawyers that is more soundly loathed than medical insurers,
by the medical establishment.

True, but there you have it. I'll have to look
about to see if I can find that particular bit of information
again.

After that, you usually
need look no further than a cost issue to explain their
behavior. I suspect ERCS is cheaper than VBAC, especially
with so many hospitals imposing rules requiring additional
resources for VBAC attempts.

Ericka, the big suspicion around here is that OBs love to do c-sections
because they make more money for the evil, money-grubbing physicians
(wink), when in fact, c-sections and vaginal delivery reimbursement rates
are, in the end, nearly identical.

To the OB, yes. To the hospital and the insurer, no.

To argue that VBAC is discouraged
because it is perceived as more expensive is a) antithetical to the
commonly-held paranoia, and b) unlikely. Look, I know the environment here
is very distrustful of established Western medicine, but physicians are not,
as a group, out to screw the ignorant public out of every dime they can,
regardless of individual patient health and welfare.

I didn't say that they were, but if you look at
virtually *any* profession, you will find that the economic
pressures brought to bear by the larger system in which an
individual's practice is embedded almost *always* coincide
with observed behavior.
In the case of OBs, they don't have to be mercenary
twits out to bilk the patient of every dime to have their
practice decisions swayed by economic forces. If their
malpractice insurance goes up if they do VBACs, then they
will do fewer VBACs, or cut them out all together, in order
to stay in business. Heck, many midwives have stopped
doing VBACs even though they believe in them because they
can't afford the insurance. If VBAC attempts consume
more hospital resources that are reimbursed at a lower
rate than ERCSs, then the hospital will institute policies
that encourage ERCS over VBAC. If OBs have to take on
greater patient loads in order to keep afloat, they have
serious pressures to minimize the time spent with each
patient. They don't have to like it. It's just the
economic reality of being in the profession.
I don't think any of us can afford to be naieve
about the effects of economic pressures on the delivery
of medical care in the US. Study after study shows that
these economic pressure significantly affect the health
care that people receive. That doesn't mean that all
the doctors are just in it for the money or that they
are insensitive to patient needs. Many doctors will be
the first to admit that they hate how their hands are
forced by these pressures. They exist nevertheless.

Best wishes,
Ericka