Health Alert: C-section births & VBAC's

Syracuse (WSYR-TV) - With one in three babies now being delivered by cesarean section, many young moms are finding they can't try for a natural childbirth once they've had a C-section - unless they switch doctors.

Connie Van-Hoesel is pregnant with her fourth child, but seeing the baby for the first time always takes her breath away.

Van-Hoesel's first baby was a C-section delivered at Rome Hospital. She delivered the next two normally, a procedure called vaginal birth after cesarean section, or VBAC. A few months ago, she found out she was expecting again.
 
"I called my OB and we said right away that if I wanted a VBAC I would have to find another doctor because my hospital banned them since the birth of my last child," said Van-Hoesel.

Since Van-Hoesel's two VBAC's the guidelines from the American College of Obstetricians have changed. The doctors group said that due to the small risk the mother's scar can rupture during labor, hospitals that do VBAC's must have an obstetrician and an anesthesiologist standing by to immediately perform a C-section. Since that change in 2007, Rome, Oneida, Cortland, Oswego and Auburn hospitals all stopped offering women the option of VBAC, they just don't have the staff.

At Auburn hospital, they're getting ready to gut the maternity floor and start a $2.5 million rehab.  All the remodeled rooms will have private bathrooms, whirlpool tubs and flat screens.
 
The hope is more women will chose to stay close to home to have their babies. The state-of-the-art maternity center won't do anything to make VBAC's available there once again.

Doctor James Blute says he commiserates with women from the Auburn area who want VBAC's, but has his hands tied. "You have to be honest with the lady and say we can not accommodate your wishes here safely and we're not going to jeopardize you or your baby to do this, but we will refer to you a place where it can be done," said Dr. Blute.
 
Van-Hoesel has chosen to deliver baby number four at Crouse Hospital.  Every few weeks, she gets a babysitter for the two little ones, and makes the drive from Rome to Syracuse to see her obstetrician. When she goes into labor, she'll have to factor in the one hour trip.
 
"I can't have a baby in that hospital, where I've had it before two times. It's very frustrating," said Van-Hoesel.

It's not just a frustration for women in small towns. Even in Syracuse, where hospitals have enough staff to comply with the VBAC rules, Crouse is the only one that regularly does them.

Facts about C-sections:

Just one decade ago 23% of babies were born by C-section. Now, that number has risen to 33%, making it the most common surgery in America.

Each one of those births costs about $2000 more than a normal delivery, and bringing with it all the added risk of major surgery.

C-Section rates:

Nationwide: 32.8%
St. Joseph's Hospital: 36%
Community General: 25.1%
Crouse Hospital: 34.5%*
Auburn Memorial Hospital: 22%
Cortland Regional Medical Center: 33%
Oswego Hospital: 27.7%

*Crouse Hospital is the regional hospital for high risk pregnancy. The overall rate at that hospital is significantly lower for average-risk women.

VBAC: Vaginal Birth After Cesarean Sections

The chances of having a C-section at St. Joseph's are higher than the national average. Nearly 1/3 of babies born there are born in and operating room. That’s because the doctors who practice at that hospital won't let a woman who has had a C-section in the past try to have a normal birth, called a VBAC.

"When I first started VBAC's I was a renegade," said Dr. Richard Waldman.

Waldman was one of the first in Syracuse to offer VBAC's to his patients, but shortly after he stopped delivering babies last year, the other obstetricians in his practice stopped offering the option. Patients received a letter from the practice saying, "If you definitely want to have a trial of labor and attempt a VBAC, you will need to transfer to a practice that supports VBAC's."

Between 60% and 80% of women who attempt a VBAC are successful, though there is a 1% risk that the scar from the earlier c-section will rupture during labor. It's a small risk, but one many doctors worried about lawsuits are no longer willing to take.

"Unfortunately we don't get sued for doing C-sections. We get sued for not doing C-sections soon enough," said Dr. Waldman. "That has really increased, I think, our C-section rate."

Women's concerns, such as the desire to have an epidural and asking to be induced to give birth, may also be contributing to the increased C-section rate.

St. Joseph's Hospital is not the only hospital alone here. Community General rarely does VBAC's, and some smaller hospitals just don't have the staff to be able to do them. That leaves Crouse Hospital, which did more than 100 last year.

After her first baby was delivered by C-section, one mother - who asked not to be identified - says she was determined to have a normal birth, a VBAC. "It was terrific, ten minutes after giving birth I got up, I had a shower. It was like I was never pregnant. I was able to hold the baby. I was able to take care of the baby. It was very, very different," she said. "You have to realize that a C-section is major surgery. You're not really able to care for your baby other people have to help you."

While a VBAC does have risks, so does C-section, especially for women who want a large family.

"The trend nationally is that the number of VBAC's is declining nationally, and it's really a shame. Because especially for women who want to have more children, the higher the number of cesarean sections, the higher the risk of complications with a subsequent pregnancy," said Dr. Robert Silverman, director of the Prenatal Center.

After two successful VBAC's, the mother says it's the way to go, and she encourages other women to talk to their doctors about options.

"I think many women will be very good candidates to be able to do a VBAC. I certainly was and it was definitely worth doing that," she said.