Multiple Cesareans: Risks and Challenges
There are various risks to multiple cesareans and to VBAmC labors.
Facing the Challenges of Multiple Cesareans:
Often a mother who is faced with her first VBAC after several cesareans finds multiple challenges not only to her ability to birth but she may also have difficulty finding a care provider who is willing to attend a trial of labor, she may lose support from her family members and she may face fears from within herself that are hard to overcome.
Challenges From Care Providers:
Obstetricians are legally allowed in all 50 states to attend a VBAmC but it is often difficult to find one who will agree to a trial of labor with normal, evidence-based care. Concerns regarding VBAmC attendance range from liability and malpractice issues to a fear of uterine rupture and negative outcomes for mothers and babies. Other health issues are also involved, such as adhesions or scar tissue from previous surgeries and possible complications such as hemorrhage or uterine atony. All of these risks complicate the surgical picture.
Midwives in various states are restricted from attending VBACs, either through practice agreements with obstetricians or through state rules on sign offs for homebirths.
There is currently NO legal restriction on a mother choosing to have a VBAmC of any kind in the United States, however the mother’s legal right to refuse any procedure can be compromised if a hospital seeks a court order to force her to have the surgery or her motherhood can be attacked for the decision by calling Child Protective Services in her state. Mothers can birth at home legally at any time, it is the care provider who is at risk if they attend and are not in compliance with their state laws.
Challenges From Family or Friends:
Often, well-meaning family members will feel they have to warn you of the dangers of VBAC. These dangers are fed by myths in our culture from TV, newspapers and care providers. Almost all research regarding a VBAmC trial of labor is encouraging.
Fears of VBAmC Mothers:
- Unsupported labors where the mother is unable to find a care provider. One care provider likened the risks of VBA2C to VBA3C to the difference between slight risk and the risk of being hit by a bus while standing in the street. This is an emotional response and not a true assessment of risk for any individual mother but it does speak to the fears of care providers who are not well-versed in the research supporting VBACs in mothers with multiple scars.
- Lack of support from spouse or partner.
- Uterine rupture.
- Transfer during labor. One mother asked, “What if I end up having to be transported? Is this what I am going to face? An irate Dr. yelling at me at such a vulnerable time? It makes me so angry that this is something dh and I have to prepare for instead of concentrating on this new blessing and addition to our family.” Many mothers having a homebirth feel attacked once they transfer into a hospital situation. As this transfer is often necessitated by a change in how labor is going, it is unconscionable for care providers to use this as a chance to harass mothers who have chosen homebirth or to attack their belief systems. If this occurs, the mother should file complaints to all applicable agencies governing the hospital or staff in order to encourage change in these policies and improve the professionalism under which appropriate transfer should occur.
- Travel during labor. Many mothers who are finding supportive care providers must do so at a considerable distance whether through traveling to the care provider or having the care provider travel to the birth.