Hindsight Quarterbacking a hospital VBAC

I recently joined My Best Birth, a network on NING.  Today I noticed that a woman posted a link to her VBAC story, so of course I had to go read.

My goodness what she encountered:

• Urge to push at 2cm dilation
• Pressure to have a cesarean
• Early epidural
• More pressure to have a cesarean
• Stalled labor
• More pressure…
• Slow dilation
• More pressure…
• Scare tactics
• Multiple birth attendants
• Fear
• Swollen cervix
• Presented with “limit of liability” and cesarean consent forms
• DH had to go fight off the OB
• A lovely doula
• Wonderful calm-inducing friends
• Finally ready to push
• Pushed in stirrups
• BABY!!!!
• Doc pulling on the placenta
• Contraction finally finished birth
• SUCCESS!!!!!

My goodness me!!

I was intrigued by a back and forth in the comments between the Feminist Breeder and At Your Cervix.  At Your Cervix was saying that pitocin augmentation might have helped speed things along for this woman.  Feminist Breeder stated that pitocin augmentation was contraindicated for VBAC… which is certainly what I thought as well.  So, I had to look.  I googled VBAC “pitocin augmentation” and one of the first things that came up was a page from Dr. Wagner’s Born In the USA (table 6) with a chart which estimated uterine rupture rates:

1 in 33,000 – woman with unscarred uterus
1 in 200 – VBAC without augmentation or induction
1 in 100 – VBAC with oxytocin augmentation
1 in 43 – oxytocin induction
1 in 20 – Cytotec induction [ref]
Have a look also at Homebirth.org’s information on “Induction or Acceleration of Labour in VBAC Candidates.”  All of this makes me understand the wide variety of rates that I’ve heard doctors cite.  Of course they never admit a .5% rupture rate probably because a large number of them induce and augment labor.  (Maybe that’s an unfair assumption, I don’t know; the fact remains that I’ve never heard a doctor actually use that rate.)  A CNM I talked to this past year used the 2% rate.  I’ve heard 1%.  I’ve even heard 5%.

I read an interesting discussion – “How high is too high for pitocin” at All Nurses Dot Com.  Definitely something to keep in mind.  I should write down some of this . . . and ask our hospital staff about their policies.

Another related resource that I highly recommend can be found at VBAC Facts, one of my favorite sites – “Two doctors respond to the Hastings Indian Medical CenterVBAC Ban . . .”  Specifically, pay attention to the charts and suggested protocols in the Leeman/Espey response.