Photo © Mariusz Blach/ photoxpress
SPECIAL DELIVERY Women’s Pavilion Offers Variety of Maternity Options
by Dr. Leonard Brabson V
aginal birth after prior Cesarean (VBAC) has been accepted as a reasonable option for delivery since the early 1980s. Before 1982, there was no scientific evidence that attempting a normal delivery after a previous Caesarean section delivery was safe. Before the middle of the last century, Caesareans weren’t nearly as common as they are today, and the procedure—called a “classic C- section”—involved making a vertical incision near the top of the uterus. Years of observation showed that when labor occurred after a prior classic C-section, there was a high probability of rupture of the uterus. This rupture resulted in disastrous outcomes for the mother and her baby. Even in the 1970s, C-sections still
were much less common than they are today, but standards of care had changed; now doctors typically per- formed an LCT (low cervical trans- verse), making the incision transversely (crossways) in the lower area of the uterus. In 1982, a large study was published showing that women who had a C-section by LCT could safely attempt a vaginal delivery with a sub- sequent pregnancy. The study showed that LCT incisions were much stronger,
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and although a small number of them did rupture in labor, when that labor occurred in a hospital facility that was prepared for immediate emergency C- section, the outcome was usually good. After that, the standard of care
that developed was that VBAC was an acceptable option if the doctor and anesthesia personnel were in the hospital during labor and delivery, and if the facility had the other personnel necessary to perform an immediate C-section if needed. As a result of these new guidelines, more women chose the VBAC option. We have done VBACs at our hospital since 1982. A few years back, two large studies, one from the United States and one from Great Britain, showed that there was a cost associated with VBACs. Although the numbers were very low, both studies showed that there were more deaths of mothers and babies when VBAC was attempted instead of a repeat C-section. Following publica- tion of these studies, many doctors and hospitals stopped offering VBACs. Now, after some reevaluation,
VBAC has again become more ac- cepted. Still the standard of care is to attempt labor in a facility that has the personnel and equipment to perform an
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immediate C-section if there is suspi- cion that the uterus might rupture. However, for a number of rea- sons—some obvious and some not so obvious—C-sections have become all too common today. As a result, there are many more women who have had a C-section who are now pregnant again and wondering if they should try a vaginal delivery. Some feel so strongly about it that they consider changing doctors and hospitals—or even having a home birth—to attempt a VBAC. Since the beginning of my career,
I have been a champion for families having choices in their pregnancy, labor and delivery—including letting moth- ers have their family or friends with them during childbirth. We started with birthing rooms and then single room maternity care. In both the birthing room and the single room (known as labor, delivery, recovery and postpar- tum, or LDRP), the concept was to provide the safety of a hospital but with less intervention and a more home-like environment. This has worked well over the years, and many hospitals have de- veloped some variation of single room maternity care, or LDRP. Some institutions also now offer a
birth center, either on or off a hospital campus. With the on-campus birth cen-
Patients at the Women’s
Pavilion can be attended by certified nurse mid- wives, opt for a water birth, and choose natural delivery even if they’ve had a prior C-section.
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