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VBAC in Santa Cruz County PDF Print E-mail
Written by Laura Maxson LM   

In Santa Cruz County, almost one third of women who gave birth in 2012 did so by cesarean surgery. Five hundred nineteen women had a primary, or first, cesarean last year, and 451 had repeat cesareans. That’s just shy of 1000 women, out of 3075, in our small county who had major surgery to give birth. While the vast majority of these women should be able to have a vaginal birth after cesarean (VBAC) for their next birth, we shouldn’t hold our breath.

Studies show that women who choose to try for a VBAC following a cesarean will have a successful vaginal birth 60-80% of the time. A scheduled repeat cesarean is 100% major surgery with all its potential complications.

Santa Cruz is failing miserably at VBAC. The Santa Cruz County Public Health Department’s publication, Births, Santa Cruz County, 2012, notes that 497 women gave birth after a previous cesarean last year. These numbers indicate that instead of the paltry 46 VBACs reported, Santa Cruz County should have reported VBACs in the hundreds.

That means hundreds of women potentially experienced an unnecessary surgery last year. Unnecessary surgery also means unnecessary pain in recovering from major abdominal surgery, unnecessary breastfeeding problems, unnecessary hospital readmissions for post-surgical complications, unnecessary costs to parents, and a unnecessary burden to taxpayers who foot the bill for Medi-cal covered care.

Why are all these clearly avoidable surgeries taking place? This quote from the American College of Obstetricians and Gynecologists’ (ACOG) 2011 publication FAQ070, Frequently Asked Questions, Labor, Delivery and Postpartum Care: Vaginal Birth After Cesarean Delivery, makes it sound simple to avoid a scheduled repeat cesarean.

“If you have had a previous cesarean delivery, you have two choices about how to give birth again:

•You can have a scheduled cesarean delivery

•You can give birth vaginally. This is called a vaginal birth after cesarean delivery (VBAC).”

But who actually has this choice? ACOG makes it sound as though the woman can simply choose VBAC, but more often than not, it is the care provider or hospital administrators who are making the decision. Many women in Santa Cruz County, as well as many other communities nationwide, are never offered a trial of labor. Still others think they are trying for a VBAC, but their care providers never actually give them a chance to be successful. Women report time and again that by the end of the pregnancy, their initially VBAC-supportive obstetrician (OB) starts making ultimatums or exaggerating possible complications as an excuse to move to a repeat cesarean, i.e., “This baby seems bigger than your last.” Or “If you haven’t gone into labor by 40 weeks, we’ll have to schedule a repeat cesarean.”

Some OBs just plain don’t believe in a VBAC trial of labor, despite what ACOG may say about a woman’s choice. (Well, let’s be clear – some OBs don’t believe in vaginal birth PERIOD, which is part of our soaring cesarean rate, but that’s another article.) Even an OB who does believe in VBAC might balk at meeting the requirement many hospitals have that the OB must be in the hospital during the entire VBAC labor. No wonder they might prefer the scheduled repeat cesarean over the wait-and-see of a VBAC.

It seems more accurate to say that an obstetrician has two choices – to allow VBAC or not. Often women are not being educated about their real choices; instead, they are trusting that they are receiving unbiased, accurate information from care providers and that the hospital is there to serve them. Both are often untrue. Many hospitals just won’t allow a woman with a previous cesarean to labor there and others place extreme staffing requirements that make VBAC a burden. At least all three Santa Cruz County hospitals currently allow VBAC, however underutilized. Monterey County is hit-or-miss with Community Hospital of Monterey Peninsula not allowing VBACs, while Natividad Medical Center is promoting VBACs at their facility.

When we look at those 46 VBACs reported in the county last year, we definitely know that the number is way too low, but we don’t know other vitally important information. Were there only 46 VBACs attempted with a 100% success rate? Or were hundreds of women given a VBAC trial of labor? Are these VBACs the result of a handful of dedicated OBs with fabulous VBAC stats or are all the area OBs doing some of these successful VBACs? We don’t know this information because it is not reported.

What’s a woman to do? Dr. Alexandra Klikoff is one OB who does make this information available. She reports a 90% success rate for her VBAC patients in her listing on Birth Network of Santa Cruz County. Many of her VBAC patients travel to Santa Cruz from Monterey in order to birth vaginally, according to Monterey VBAC chats online. Unfortunately, one OB can’t take on all the county’s potential VBACs.

Women need to know local obstetrician’s VBAC rates, which OBs share call with them, and their rates. Women need to take non-hospital childbirth classes. They need to get connected and get supported. In order to have a successful VBAC, many women need to fully process their first birth experience, which often means finding a supportive group and telling her story several times. 

 

Side bar:

Birth Network’s local provider list – www.birthnet.org

VBAC support group – www.santacruzvillage.com

VBAC info - www.ican-online.org/

Birth Stats - www.santacruzhealth.org/pdf/2012%20Birth%20Data.pdf

 

Laura Maxson, LM, CPM, the mother of three grown children, has been working with pregnant and breastfeeding women for over 20 years. Currently she is the executive director of Birth Network of Santa Cruz County and has a homebirth midwifery practice. Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


 

 
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