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Vaginal Birth After Cesarean Section- Can I have a VBAC? -with Dr. Tami Michele

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(With Dr. Tami Michele, mama of 4 kids, Ob/Gyn, former Doula & Childbirth Educator) You’re sitting patiently {okay, you’re a wee bit nervous} waiting for your doctor to walk in. You have a very important question to ask. It all started as an “I wonder if…” thought. After looking back, you weren’t happy with your first birth dead-ending in a cesarean-section (the way it all went down, the reason it happened, the “lack of” detailed communication by your provider…deep down you think you could have had a vaginal birth IF you had taken a more active role), but now it’s entrenched on your mind. In walks the doctor …here goes… you lob the question….”I want to try for a Vaginal Birth After Cesarean Section. Can I have a VBAC?”…crickets…

The doctor slowly looks at you (you see that look of a *sigh* all over their face) & says… “Sorry, we don’t do VBACs here- once a c-section, always a c-section.” And so you think your door is slammed. Not so fast turbo.

Questions swirl round & round anytime VBACs (pronounced ‘vee-bak’) are mentioned. Questions like… “Are VBACs safe?” “Am I a good candidate for a VBAC?”  ”I’ve heard something about uterine rupture during VBAC?” “Why won’t some doctors do VBACs?” “Why is it hard to find a doctor to do a VBAC if the Evidence supports them?” “I’m being told my baby is too big?”…and on & on.  

YourBabyBooty.com Can I have a VBACLet’s just cut to the chase shall we?  We compiled your important questions & tracked down Dr. Tami Michele Ob/Gyn, who has a special interest in VBACs, to get you answers.  It’s estimated between 60%-80% of VBACs will be successful (according to Mayo Clinic). “VBAC is a reasonable and safe choice for the majority of women with prior cesarean” says this study at the US Department of Health & Human Services. If you are even remotely thinking about a VBAC, listen to this interview.

The best available Research & Evidence does not support the old school “once a c-section always a c-section” medical thought process. You have options. But only if you learn what they are.

VBACs are not right for everyone. Every woman is not a good candidate for a VBAC. But a VBAC might be your best option. It might be the safest option. It might be the option you want. If you had a c-section with a previous birth, you MUST listen to this interview (even if you don’t want a VBAC- you’ll still be better prepared for your c-section).  It’s a gold mine of candid answers to your very important questions.

You’ll Also Learn:

  1. What are the risks of a Vaginal Birth After Cesarean Section & Why consider a VBAC?
  2. Why don’t many Doctors support VBACs?
  3. What steps should I take once I decide to have a VBAC?
  4. Why finding a doctor  who says ‘yeah, we’ll try a VBAC’ doesn’t cut it. You need a doctor who says ‘I support you- here’s what I recommend we do to achieve your goal. And here’s our plan B if that doesn’t work” Big Time difference. 
  5. Why a Doula is crucial if you want a VBAC. 

Links to check out: http://www.nih.gov/news/health/mar2010/od-10.htm & Understanding the Dangers of Cesarean Birth: Making Informed Decisions by Nicette Jukelevics

Who is Dr. Tami Michele?

She’s one incredibly talented woman! And she’s seriously dedicated to helping women bring their babies into this world. Dr. Tami Michele is the mama of 4 kiddos.  She started as a Doula (13 years), then become a childbirth educator, then realized she wanted to kick it up a few notches, so she became an Ob/Gyn. Dr. Michele currently lives and practices in Fremont, Michigan. She has a unique & important “birth perspective” that many doctors, nurses & other professionals clamor to learn from. Dr. Tami Michele is the real deal.

 Click here to listen to the Interview (this is audio only)

 

What do you think about VBACs? Share below…

 

 

Transcript

 

Dr. Tami Michele- Vaginal Birth After Cesarean Section (VBAC)-

Can I have a VBAC? Once a C-Section always a C-Section. 

[0:00:00]

Sarah Blight:               Hi, this is Sarah Blight with Your Baby Booty Interviews, where we cut through the fluff and give you the information that you want to know and need to know about becoming a mom. Well, do you have questions about VBAC, Vaginal Birth After Caesarean? Well today we’re chatting with Dr. Tami Michele. She is a mama of four kids. She was a doula for 13 years and a Bradley Childbirth Educator before becoming an OB/GYN, and she currently lives in Michigan. Thank you so much Dr. Michele for being with us today.

Dr. Tami Michele:       Well thank you for having me.

Sarah Blight:               So, what are you the most inspired to share with future moms? Or what can you wish you would have known when you were pregnant for the first time?

Dr. Tami Michele:       Well, I think it’s important to find out everything that you can to help yourself through labor. When women turn to their doctor and rely solely on their doctor to get them through the experience, they feel like, when it’s all over and done, that they wish they would have known more. So I really appreciate people like you that are bringing education to women, so that they can make important choices that affect the outcome for them and their babies.

Sarah Blight:               Hmm, that’s a really good point. So today we’re chatting about VBAC, um, vaginal birth after caesarean, um, can you tell us what that means? I mean, we can hear those words but what does that actually mean?

Dr. Tami Michele:       Well, having a VBAC is something that has to be considered very carefully, so that the mom can make the best choice for her in her circumstance, and after a caesarean, there are some increased risks that we would like women to know about, and then put those risks in perspective and look at the criteria that goes along with having a safe VBAC.

Sarah Blight:               Okay, we’re going to get to some of those more specifics in a minute. Why would a mom want to consider a VBAC, or why might she want to consider a VBAC?

Dr. Tami Michele:       Well, in March of 2010, the National Institute of Health had a large conference, where they collected all the research. The research was collected by the agency for healthcare research and quality, a national organization that carefully looks at the research available when making medical recommendations for doctors to follow.

Sarah Blight:               Uh-hum.

Dr. Tami Michele:       During the National Institute of Health conference, they discovered that there was increasing mortality in this country related to caesarean sections. They then looked at all the criteria for all VBAC delivery, and they found that it was actually safer for women to have a vaginal delivery after a c- section than to have a repeat c- section.

Sarah Blight:               True thing—okay, so why haven’t we heard about this? [Laughter] Why does it still feel like—and we had a mom ask this, this in our facebook page, why is it hard to find physicians who will do VBAC if that’s the case? Is it just a matter of kind of educating the physicians about this?

Dr. Tami Michele:       Well, changes happen very slow in the medical field, and it’s not that doctors are against VBAC, some are very cautious, but the bigger changes that need to happen come from the medical malpractice companies that insure doctors. If doctors don’t have medical malpractice, they can’t work for hospitals. If they can’t work for hospitals, they can’t take care of women, so that’s one of the biggest things. Also, hospital administration looks at the financial side of offering a VBAC.

The current recommendation set by ACOG, which is the American College of Osteopathic—or, let me correct that, American College of Obstetricians and Gynecologists, they put out recommendations of standards of care of how doctors should be taking care of women in obstetrics. And in their recommendations, it says that the surgical staff and anesthesia should be immediately available to a woman who is in labor, attempting a VBAC. Well many hospitals can’t comply with this financially, because that means all these people, for a surgery crew and an anesthesiologist, and the doctor also, is sitting in the hospital, waiting for that baby to be delivered, just in case there is a risk.

Sarah Blight:               Mm-hmm, okay, so it—that’s interesting. So it would be different if you scheduled a C-section, cause everyone knows it’s going to happen rather than basically all—just hoping that people being on- call in case they’re needed.

Dr. Tami Michele:       Right. A scheduled C-section is easier for the doctor. They spend approximately 1 to 1 ½ hours with the patient, as compared to a vaginal delivery, the estimate has been—it takes about 17 hours of patient care sign. Um, it’s better for the hospital because they schedule it, they know when that patient’s going to be in, they can have their surgery crew available, and again, they’re only committing about an hour of time.

Sarah Blight:               Okay. So as far as why—okay, so it’s maybe even safer now to have a VBAC than to have a repeat Caesarean. Why else would a mom, just more of a like a personal standpoint, why might she want to consider having a VBAC?

[0:05:40]

Dr. Tami Michele:       Well, she’s going to feel better right away. She’s going to feel better, able to take care of her child because she’s experiencing less pain. Breastfeeding gets off to a better start after a vaginal delivery.

Sarah Blight:               And why is that, Dr. Michele?

Dr. Tami Michele:       With the breastfeeding?

Sarah Blight:               Yeah, why does breastfeeding usually…

Dr. Tami Michele:       Well, during a Caesarean delivery, the baby is handed off to the nursing staff, where the baby’s evaluated and it can’t go right to the mother skin to skin. There are some hospitals around the country that are starting to do this, and we’re looking at it at our hospital too for future, um—but it’s more difficult to make that happen when you have a sterile field of surgery. It takes time to get the mom back to her room where she can get the baby in her arms and comfortably start nursing.

Sarah Blight:               Okay, okay. Um, so I heard, um, you know, physicians—I read things online where doctors kind of say that—you know, the risk of uterine rupture doubles if you try to have a VBAC. What is the—what is uterine rupture, and is that true?

Dr. Tami Michele:       Well, there is a true risk of uterine rupture. The rate is low and, depending on the study that you look at, it’s somewhere between 0.4 to 0.9%, so doctors often round it up and say 1% of VBAC deliveries will have a uterine rupture. That means that there’s a tear in the muscle of the uterus during labor or during pushing, and it can be serious. But of the babies that are born to mothers that have had a uterine rupture, 1.8% of babies will die. So, we have to put the numbers into perspective. Let’s say that there’s 0.5% uterine rupture, that’s [0:07:53][Phonetic] average, that means 1 in 200 of moms laboring may experience this. But there’s also a 99.5 chance that it will not occur.

Sarah Blight:               Right.

Dr. Tami Michele:       Yes, it does occur. There’s then a 98.2% chance that the baby will not die. There can be some serious, um, neurological things that could happen during the uterine rupture, and that happens in about 6.2% of the cases. So overall, even when the uterine rupture does occur, if the woman has immediate access to a Caesarean section to get the baby out, she and the baby will do fine.

Sarah Blight:               Okay. Um, so, we talked a little bit about this at the beginning, um, just that doctors seem to be uncomfortable or against VBACs. Um, why is that?

Dr. Tami Michele:       Well, doctors are under the pressure of the organization that they’re working for.

Sarah Blight:               Uh-hum.

Dr. Tami Michele:       And, you know, again it goes back to the financial status of the hospital and if the surgery staff is available, if anesthesia is available. In community hospitals, those personnel are often on call. It means they are immediately available, but they’re not right in the hospital. And hospitals are set up so they have emergency plans in place, so that when another [0:09:13][Inaudible] emergency happens, they can do a caesarean within 30 minutes.

Sarah Blight:               Uh-hum.

Dr. Tami Michele:       Um, doctors are also, you know, at the mercy of their medical malpractice insurance and that—they’re mandated that that cannot be done according to their malpractice insurance, um, you know, it’s not always the personal choice of the physician, but it’s the requirements that they’re working under.

Sarah Blight:               Gotcha; that makes a lot of sense. So, what do you tell a mama who says, “You know what, I think I want to try to have a VBAC”. What does this mama need to know about either finding a doctor or a scenario where she’s going to be able to have that opportunity? How does a mom go about that?

[0:10:21]

Dr. Tami Michele:       Well, first, the moms need to know that a lot of hospitals are actively working on this right now to decrease the barriers to VBAC. Some of the hospitals are not all there yet, but there’s a lot of planning going on, so the first thing is to find a hospital that already has VBAC available.

Sarah Blight:               Okay.

Dr. Tami Michele:       Second thing is to find a doctor that’s supportive and not only will allow her to do it, but be supportive of that choice and help her do everything that she can to be successful.

Sarah Blight:               Uh-huh.

Dr. Tami Michele:       The other biggest advice that I can give is every VBAC mom needs a doula.

Sarah Blight:               Mm, and why do you say that?

Dr. Tami Michele:       It takes a lot of emotional energy to get through labor and to get through a labor without the use of an epidural is going to increase the chance of having a normal delivery.

Sarah Blight:               Uh-hum.

Dr. Tami Michele:       And, uh, decreased use of medications can help also, and a doula is really good for helping a mother achieve her goals. Getting up out of the bed using different positions to help the birth process along.

Sarah Blight:               Do most women who have VBACs, is that—is it a given that they’ll do without an epidural, their—or is it, I mean, are there… I guess restrictions; do they need to do it without an epidural, could they do it with an epidural?

Dr. Tami Michele:       Um, there’s no…

Sarah Blight:               Is it just a personal preference?

Dr. Tami Michele:       It’s a personal preference, and sometimes…

Sarah Blight:               Oh, okay.

Dr. Tami Michele:       a VBAC woman will have fear of the pain of the childbirth—depending on her first experience, you know, a lot of these decisions are made on how did that first birth go and what led to needing that caesarean. If they had a very long, painful labor, a lot of pitocin was used, things like that—they may be fearful of what it’s going to feel like. Some of those women choose and epidural and can still be successful.

Sarah Blight:               Oh, okay.

Dr. Tami Michele:       [0:12:31][Inaudible] women feel that they need more mobility during the birth process. To get up, move around, trying to help the baby adjust to the pelvis, and that will make them be successful. Well you can’t do that if you have an epidural, so the epidural’s going to be the personal preference, um, but there’s no reason that an epidural must be used during a VBAC.

Sarah Blight:               Gotcha, okay. Um, what are the success rates or what are the—do you have stats on women who attempt to VBAC who are successful and have that experience?

Dr. Tami Michele:       Well, before I came to Michigan, I had a very large VBAC practice, and in fact there was women that would drive four hours to get to my practice to have the combination of a supportive doctor and a supportive hospital. Our success rate was 87%.

Sarah Blight:               Wow.

Dr. Tami Michele:       And it was amazing, it was so good…

Sarah Blight:               What state was that in?

Dr. Tami Michele:       That was in Kansas.

Sarah Blight:               Okay.

Dr. Tami Michele:       And, I did require all of my patients to have a doula with them. I had a wonderful staff of doulas that would work with my patients, they did a great job, and the women were very committed. I mean, doesn’t matter to them, and they wanted to work through their obstacles to get their birth. We had very good outcomes. During that period of time we had no uterine ruptures, we were very careful about inductions of labor, so it can work very well. The national average is 70% success rate is expected. Locally, um, where we’re living right now, it’s about 36-38% success rate.

Sarah Blight:               Okay. And what do you attribute that 36-38% as opposed to say the – let’s say the national average, 70% or maybe even—it might be easier to compare it to your personal, um, in Kansas of 87%. Do you attribute that to the doula and just, kind of the all- encompassing, supportive, not just saying, “Okay, you can have a VBAC, but actually…” like really, like working with women, or—what do you attribute that to?

[0:15:02]

Dr. Tami Michele:       Honestly, I think the doula component has a lot to do with it. Um, I don’t see a lot of people in the area where I’m working now, are choosing to have doulas and I think there is a big impact on the outcome. Um, and between that and a supportive environment.

Sarah Blight:               Uh-hum. So that’s kind of where you’re really encouraging mamas to find a doctor who supports and will do everything to really help you achieve that goal is really important, not just someone who’s like, “Okay, you can try” [Laughter] But someone who’s like, “I’ll work with you, yeah”

Dr. Tami Michele:       Exactly, and when you have a doula involved, you tend to work with your natural labor contractions a little bit better and then there’s less need for interventions.

Sarah Blight:               Uh-huh. Um, what do you say to the woman who says, “You know, I had a C-section before. It wasn’t exactly what I wanted at the time, but it’s what I know and I’m just going to go and have it again, cause—at least I know what to expect.

Dr. Tami Michele:       A lot of women feel comfortable with that at the beginning, just because it is familiar. When they have women like that in my office and I’m counseling them, their next baby and what choices they’[re facing, I encourage them to do a lot of research, they don’t have to decide at their first visit in my office. I ask them to do some reading, get on the internet, learn as much as they can, I provide them with information, an informed consent, and I want them to truly look at the risks and, um—in all the components that come into decision making, and then I encourage them to come back, express their concerns to me so we can talk through them, and in the end if they decide that that is the safest route for that pregnancy. Um, you know, it all permanently comes down to their choice.

Sarah Blight:               Uh-hum.

Dr. Tami Michele:       But I have to help them with where the place of birth is going to be. It’s not all hospitals that are offering that.

Sarah Blight:               Okay, what—um, we talked a little bit about uterine rupture. Are there any—what are the other risks with having a VBAC?

Dr. Tami Michele:       Well, both a repeat caesarean section and a trial’s labor or a VBAC have risks. The risks include hemorrhage; that can happen in any deliver—I mean, even in a vaginal delivery, um, possible requiring a blood transfusion, there’s a risk of infection between both a planned, repeat c- section and a vaginal delivery. So a lot of these risks you have to kind of sort out, because there’s always a risk with birth.

Sarah Blight:               Right, of course.

Dr. Tami Michele:       Um, after—or with a VBAC risk, that would also have any of the risks that go along with a normal vaginal delivery, you can get shoulder dystocia, where the shoulders get stuck and could be damage to the baby. Um, you know with a repeat c-section, you can have blood clots that develop in the legs or in the lungs related to the surgery, and with some repeat c-sections, there can be problems with how the placenta had attached and it could even lead to a hysterectomy, if there was too much bleeding.

Sarah Blight:               Okay. So, it sounds like what you’re saying is, there’s definitely risks no matter what in childbirth, there’s always going to be a risk.

Dr. Tami Michele:       There’s always risks, yeah.

Sarah Blight:               Um, and it sounds like it’s really important—I’m sorry?

Dr. Tami Michele:       There’s always a risk. No matter the situation, it’s just weighing out what the risks are and what risk the woman is willing to accept.

Sarah Blight:               Mm, okay, well we have some questions...

Dr. Tami Michele:       It’s not an easy decision...

Sarah Blight:               Right, well yeah, and it sounds like, um, that’s where it’s really key to have a supportive healthcare provider who can really help walk you through that and kind of navigating that territory. Um, we have some questions that mamas ask us a lot that we wanted to ask you on their behalf.

Dr. Tami Michele:       Okay.

Sarah Blight:               Um, we’ve had a couple of mamas who said that, you know, I’m nervous because I had a c-section the first time because the baby was too large. Um, can I still have a VBAC?

Dr. Tami Michele:       I feel like a woman could always attempt a VBAC. Um, with a large baby, the doctor will have a talk with the mom. If this next baby feels like it’s going to be big, is measuring big, or the ultrasound measurements show that it could be big, um, the mother is going to weigh out the risks of the shoulder dystocia with her doctor, versus of a repeat c- section. But a vaginal delivery could still be attempted. If it’s showing that the baby’s too big for the pelvis, the labor is not going to progress well, the baby’s not going to descend well into the pelvis, so the labor—we call the labor curve, um, how quickly they’re dilating over time, and if the labor curve is off, that could be a sign of labor dysfunction, that the baby is not fitting well. So decisions can be made along the way, also, while the woman is in labor.

[0:20:54]

Sarah Blight:               And are those—is it, I mean, it’s funny. It seems like people are all over the map. A lot of women say, “Oh, my baby’s measuring really big” and then she has kind of a, you know, not a—I wouldn’t say a huge baby. Are those measurements—are they accurate?

Dr. Tami Michele:       No, it’s not a perfect science. It’s always an estimate and ultrasound measurements in the third trimester of pregnancy can be off by two pounds.

Sarah Blight:               Wow, that’s pretty substantial.

Dr. Tami Michele:       Yes, it is. It’s very hard to use that alone in making decisions.

Sarah Blight:               Okay, okay, um, and we also had someone who said, you know, I’m nervous because I had a c-section the first time because I failed to progress—failure to progress. Can I still have a VBAC and why?

Dr. Tami Michele:       Well, every labor is different, every baby is different and the way that it’s positioned, and it does not mean that that’s going to repeat itself again. Spontaneous labor is always the best. If it can happen, we try to avoid inductions in the VBAC mom…

Sarah Blight:               And why do you do—why do try to avoid inductions for VBAC?

Dr. Tami Michele:       If we used pitocin, that drastically increases the risk of uterine rupture. Using pitocin in a person who has not had a scarred uterus, that has, you know, never had a c- section or a surgery on her uterus, still has a risk of uterine rupture. So when we add…

Sarah Blight:               And is that because the pitocin makes the contractions a lot stronger than your body would normally have, is that why?

Dr. Tami Michele:       Yes. Yes, it puts more stress on the uterine muscle.

Sarah Blight:               Okay. So if possible for a VBAC mom, you want them to just—when you say spontaneous labor, you mean the baby is the one who determines when it’s go time, not the doctor, not a mom [Laughter]  They’re sick of being pregnant [Laughter]

Dr. Tami Michele:       Exactly.

Sarah Blight:               Okay.

Dr. Tami Michele:       And, that’s something that the woman and her doctor would discuss, on how far past her due date would be appropriate before thinking about an induction. There’s a procedure called atrium cervical balloon, and it’s a little balloon that can go through the opening in the cervix, it puts a little pressure in there, and it can stimulate the body to begin labor without using pitocin, so some doctors are using that as an induction method if it does become necessary. Some doctors will let the mother go up to two weeks past her due date before intervening. It’s a conversation that the woman has to have with her doctor.

Sarah Blight:               Okay. Are women who’ve had more than one c-section still able to do a VBAC?

Dr. Tami Michele:       That is one of the things that also came out from the National Institute of Health last year, that they now say a woman with two prior c-sections should be allowed to have a vaginal birth after a c-section. Um, there is a little bit of increased risk, instead of a 1% risk it goes up to about 2-3%, so again, the woman has to take that into consideration when making her decisions, but it can be done.

Sarah Blight:               Okay. Um, can women have a VBAC outside of a hospital setting, say birth center, home birth, is it possible?

Dr. Tami Michele:       Many women are choosing to do that, because of the restrictions that hospitals are placing on them, or the barriers to care that they’re finding, depending on their geographical location to a hospital. Um, many women live far away from the hospitals that are doing VBAC and it’s difficult for them to drive that distance while they’re in labor, so a lot of these women are choosing to have a midwife come to their home.  Or, a birth center birth, where birth centers are available. So yes, women are choosing that. The other thing is that, with these restrictions that are put on doctors and hospitals that are not providing VBACs, a lot of the burden for caring for women has been put on the midwife, because now women are coming to them, saying, “I need your help, will you help me?” to attempt a VBAC outside of the hospital.

[0:25:30]

Sarah Blight:               Uh-huh, and I’m guessing it’s probably some more with OBs, there are probably midwives who are comfortable with that, and maybe OB—err, and midwives who maybe aren’t comfortable with VBACs or definitely want to make sure that they know your history. Would you agree with that?

Dr. Tami Michele:       Um, many of the midwives that are providing those services are trying to screen women to, you know, have them—have the safest options available, and you know, depends on how many c-sections they’ve had, any other medical complications that they may have had, how closely the pregnancies are spaced, there are several things that they take into consideration.

Sarah Blight:               Okay. So who is a good candidate for VBAC and why?

Dr. Tami Michele:       That would be a woman with a low risk pregnancy—meaning that she doesn’t have any other complicating risk factors medically. Um, one baby, although they are also saying that now you can have a VBAC with twins. With the surgical procedure that we’ve done during the c-section, they are recommending if you’ve had a double layer closure of the uterus, that that would be the safest indication, although they don’t rule out if you had a one layer closure, they don’t say you can’t try, just…

Sarah Blight:               And what does that mean, Dr. Michele? From a non… [Laughter] A person who [0:27:06][Phonetic]

Dr. Tami Michele:       When the baby is delivered thorough the incision that’s made in the lower part of the uterus, then that muscle is put back together, stitched back together during surgery, we like to put two layers in. And—so it just reinforces it a little bit more.

Sarah Blight:               Oh, okay, gotcha, okay. Is there anything that a woman needs to do to prepare for a VBAC?

Dr. Tami Michele:       Well I think education is number one, and she needs to know all of the true risk that go with it. So educating herself and just making that choice and what that means. Then the second part of it is what can she do to help herself be most successful and we had talked already about having a doula, that supportive person that can help her get through labor contractions, that will decrease her need for an epidural or other interventions.

Sarah Blight:               Uh-hum. Are there any like exercises, I mean, obviously, I mean, in a normal pregnancy it’s good to eat healthy and exercise, um, are there any other magic things that you can [0:28:25][hear?] to me to really insure that you get the VBAC?

Dr. Tami Michele:       Yeah, I encourage all of the women that I work with to practice squatting during their pregnancy to increase their flexibility, which will then, during the labor process if they’re utilizing those other postures and positions, it can open the pelvis and really increase that pelvic outlet, so it will increase their chance for success. Sometimes you have to try a lot of things during labor.

Sarah Blight:               Uh-huh, and see what works. [Laughter]

Dr. Tami Michele:       Yup, and getting the women out of bed seems to be key. They have to be moving around so baby has mobility to adjust to the uterus. We see so many c-sections occur just because the baby’s in a wrong position, and if the baby’s in the wrong position and then she gets an epidural, if the baby gets stuck in that position, then we get failure to progress.

Sarah Blight:               Mm, right, okay.

Dr. Tami Michele:       The baby has to come out.

Sarah Blight:               Right. So, what other resources—I’m guessing we can probably find—and I will try to find this and link it below, this interview, the NIH—the study from March of 2010 that you talked about. Um, is there—are there any other resources that mamas can check out that are—will kind of give them the real scoop on VBACs?

Dr. Tami Michele:       Yes, there is a book that I would like to recommend, it’s called, “Understanding the Dangers of Caesarean Birth”—kind of a scary title. The subtitle is, “Making Informed Choices”.

Sarah Blight:               Okay.

Dr. Tami Michele:       The author is Nicettle Jukelevics.

Sarah Blight:               Okay, okay…

Dr. Tami Michele:       And it will help women sort through a lot of the informed consent.

Sarah Blight:               Okay, great. Well to all the mamas who are listening to this interview, if you guys have any questions or comments about VBACs, we’d love to hear them. Please leave them in the comment section below, and we’ll make sure that we interact with you and chat with you about it. Thank—special thanks to Dr. Michele for giving us the low down on VBACs, we really appreciate you spending time with us today. Thanks everyone for listening, we will catch you guys later.

[0:30:49]                      End of Audio

 

  • runthegamut

    I had a VBAC with a classical scar. I’m curious what Dr Michele’s opinion is on VBAC with non-standard scars.

    • yourbabybooty

      Great question! She did say that the type of incision plays a role in being a candidate for VBAC. I’m guessing that each physician has a varying comfort level with the types of incisions they are comfortable working with.

  • Asicsgirl

    I had a 36 hour labor. Baby was OP. she had severe meconium aspiration after birth. I was dxd with chorioamnitis and failure to progress. Had a csection. My midwife practice has an 80% vbac success rate. I have been told having a vbac comes down to which attending is on service. What would you recommend to do in this scenario? We have a laborist system in our hospital, so you never know who will be on service until you go into labor. Thanks so much for your insight. Very much enjoyed the interview! Very inspiring!

    • yourbabybooty

      Thanks for your thoughts! I’m not completely familiar with the laborist system- is there a chance someone NOT from your practice might be catching your baby?

  • Lyn L.

    Don’t get me wrong, I love medical care, I love my doctors & respect most physicians…but it’s ridiculous and borderline criminal that so many doctors *won’t* help moms with VBACs when the evidence & studies show they are safe. We pay healthcare providers to provide us with better health, not to refuse evidence based care because they are too scared of possible litigation. I understand doctors get sued, I understand they aren’t in an easy position. But you chose to be a doctor. That is no excuse to not stand up & do what is right. Because they don’t want to “risk a lawsuit”, they transfer unnecessary risk onto moms who have to get another c-section. That is unacceptable on all accounts. In fact it’s infuriating. Hey Doctor…”If you won’t provide evidenced based care…then go find another career. You’re in the wrong biz.” That’s what I think.

    • http://twitter.com/YourBabyBooty Sarah Blight

      Thanks for sharing your thoughts Lyn. Unfortunately we live in a very litigious society, where people sue others over all kinds of stuff (legit and not legit). Keep in mind that even if a physician supports VBACs, they need to have privileges at a hospital where they permit them. It comes down to a whole lotta bureaucracy and insurance:( Unfortunately:(

  • Saba Haider

    i am at 39weeks of pregnancy.n its my second baby.i have a section before.the reason for section was unengaged head.n uterus tigtly closed.same situation i am facing in my second pregnancy.dr has preffered elective section.i want to ask if i am a VABAC or not vid free floating head.should i wait for labor or not

    • yourbabybooty

      Hi Saba, thanks for your email. I’m not sure I understand your question- but I would say that having an honest chat with your provider is definitely the way to go. Have you let your Dr. know that you want a vbac?

  • Saba Haider

    yes.i told her.n she said she is unable.her advice is section.n i want vaginalbirth.she says that normal delivery is not possible with unengaged head of baby.i wanna ask really i have no chance to b vbac?plz helpme out.i dont want section again

    • yourbabybooty

      The best thing would be if you could find a new provider who does vbacs. Where do you live? If you don’t have a vbac friendly provider available, then waiting is your best bet..provided the baby is doing well (still active and kicking). Your baby is the one who decides his/her birthdate, 40 weeks is an average, it’s not a clock that says “ding! Baby is ready” Perhaps the reason your baby hasn’t dropped is that he/she is not ready. Just one thought. Again, the choice of provider is crucial to getting the best outcome for you and baby. Hopefully you can work with your provider as the dream team:) Best of luck!

    • yourbabybooty

      Check out this link Saba! They have great information about this exact thing- http://spinningbabies.com/more-info/for-pregnancy/38-weeks-is-baby-engaged-yet

  • Samantha Kimberly Smith

    I am currently pregnant with my 4th child. I had 3 previous C-sections. The first was due to pre-eclampsia. The doctors first induced; however, after over 15 hours of labor and not dialating I had to have a C-section. The second was the story every one hears, “you can do a VBAC but a repeat C-section is the safest” and with the stories I was told and the way our local hospital is I listened and did the 2nd C-section. Of course the 3rd is a no brainer, “you can do VBAC after 1 but never after 2.” During this pregnancy I have been doing research and have read in many articles it has now been found safe to have a VBA3C. I was wondering if you could tell whether this is true or not and if so, do you happen to know of a hospital/doctor in NC which will do this or of a website I can look one up on?

    • yourbabybooty

      Samantha, where in North Carolina are you? I am happy to put out some feelers and see if there are vbac open physicians in your area. Also, I know that it typically depends on that type of incision you have and the reasons you had a c-section in the first place. Please email me at sarah@yourbabybooty.com and I will do my best to see what I can do to help you.