Did you know we have a podcast? We publish weekly and interview women who share their VBAC journeys with us. We also have a little fact about VBAC and cesarean prevention at the end of every episode. If you haven't tuned in yet, you should! While listening to these women's stories week after week we notice a huge trend in the reasons for their initial C-sections. They mostly all fit into four categories. Some are necessary, some may have been avoided. Here we are going to walk through each of these primary reasons with you and provide you with critical need-to-know information to help you avoid an unnecessary Cesarean.
Historically, evidence has shown that many care providers do not give women the chance to progress in the first stage of labor (dilated to 10 cm) or enough time to push the baby out when they do get there. In 2011, ACOG (American College of Obstetrics and Gynecology) and SMFM (the Society for Maternal-Fetal Medicine) put out an updated definition on time limits for the first and second stages (the pushing stage) of labor. The new guideline says that a woman is not considered to be in active labor until six centimeters and cannot be termed as “failure to progress” until she is at least six centimeters dilated, her waters have ruptured, and no cervical change has been made in six hours of labor.
For the second stage of labor, there is no time limit for pushing the baby out and pushing can continue for up to three to four hours as long as mom and baby are stable. Many women certainly had their primary cesareans because their care provider did not give them enough time to labor or push. A mother’s emotional state and ability to cope with physical discomforts also plays into the body’s ability to labor effectively.
Fetal Heart Problems
In a hospital setting, continuous fetal monitoring is usually a requirement for VBAC women, and in about 70% of rupture cases, EFM (external fetal monitoring) has picked up an abnormal heart rate pattern that can suggest separation of the scar (ACOG, 2017). However, it is also normal for the heart rate to fluctuate outside of normal readings. A heart rate dropping several times or one that drops and doesn’t recover may be resolved by simply changing positions to adjust baby’s position in relation to the cord.
There are many things that can be done to ensure baby is in a good position prior to labor starting and to get baby in a good position during labor. Things like getting on your hands and knees, squatting, not laboring on your back, and being mobile help significantly. Your doula should have a rebozo that can work magic on a baby’s position. In 2018, ACOG released Committee Opinion 745 on breech presentation and it states:
“There is a trend in the United States to perform cesarean delivery for term singleton fetuses in a breech presentation. The number of practitioners with the skills and experience to perform vaginal breech delivery has decreased. The decision regarding the mode of delivery should consider patient wishes and the experience of the health care provider. Obstetrician–gynecologists and other obstetric care providers should offer external cephalic version as an alternative to planned cesarean for a woman who has a term singleton breech fetus, desires a planned vaginal delivery of a vertex-presenting fetus, and has no contraindications. External cephalic version should be attempted only in settings in which cesarean delivery services are readily available. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for eligibility and labor management. If a vaginal breech delivery is planned, a detailed informed consent should be documented—including risks that perinatal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned.”
By now you should already know how we feel about this. If your doctor is diagnosing you with a pelvis that is too small, CPD (Cephelopelvic Disproportion) or telling you that your baby is too big, read the blogs linked previously. It might be time to find a new provider who practices evidence based care. A TRUE diagnosis of CPD and a baby that is REALLY too big are incredibly rare and unlikely in healthy women with no history of trauma to the pelvic area.
Are you over the VBAC myths and want solid data to back up the facts? Grab your FREE VBAC MythBusters guide here.