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Tuesday, April 22, 2008

VBAC article in the TCPALM today

Today there was an article in our local paper on VBAC. I posted the following response in the comment section. It was very hard limiting my comments to 3000 characters.

When I was in residency (1995) VBAC wasn't a big deal. We checked prior birth records to make sure the incision on the uterus was horizontal and moved forward. We scheduled repeat C’s for prior vertical uterine incisions which were fortunately rare.

As the article states ACOG’s new policy in 2004, resulted in nationally hospitals tightening their criteria for who can have VBACs. Many of my friends who had a recent cesarean and were told that a future vaginal birth was no big deal were now being told by the same MD that they could not birth naturally. A woman whose goal is to succeed at VBAC has to overcome a lot of external mental conditioning that she would not have had to deal with a year ago IF she can find a provider. Likewise, women in my training years having a VBAC did not have to overcome such emotional adversity.

ACOG is the governing body for obstetricians and GYNECOLOGISTS. ACOG needs to be concerned with women of all ages and phases including acute and chronic surgical gynecology.

There is another expert who is dedicated to ONLY pregnancy. That is the midwife. Midwives have different accountability organizations, different perspectives, and do not supervise the care of women with serious illnesses distracting her specialty of birth. They often have only a few women under their care at one time.

Furthermore when I was in residency, I was not exposed to midwives and their skills. I did not know what a midwife was. I was only exposed to the high risk, interventioned births that filled our maternity wards. My training was not well-rounded. As a physician-to-be my training limited me to the medical birth. My Family Medicine Department did not share many of the views the OB department held and introduced me to some controversy surrounding birth practices.

Not until I had my own birth in a local TC hospital, did I realize how influential birth is to a women's well-being. Many of the complications I witnessed in my residency training were iatrogenic (caused by our medical interventions). My next birth at the hospital was with a doula that protected my birth plan. My third birth was a footling breech born safely in my own bed with a midwife. My obstetrician father-in-law thought I was crazy, but the breech presentation caught me be surprise and I later learned breeches are delivered vaginally around the world.

Now I am in a unique practice setting focused on wellness. Many of my babies are born at home. It is such a pleasure to serve these healthy families. I have no doubt that the circumstances surrounding one's birth influence one’s immediate health and long-term health. While bonding with your baby is possible and health of mother and baby can be maximized after a difficult birth scenario, all other supports and conditions must be optimized. Inform yourself about natural pregnancy and seek a second opinion from your independent midwife.

Denise Punger MD FAAFP IBCLC


Lauren said...

I read that article in the paper this morning. It was entitled "A Mother's Joy", but the mother's quotes regarding the birth were far from joyful.

crispy said...

Good for you to be an advocate for mothers everywhere.

Jenny said...

Help! My name is Jenny and I live in VA. You can see my family at I am pregnant and due Aug. 3rd. I had one c-section way back in 1990 and had three successful v-bacs in 1994,1997 and 1999. My real problem is that I had to have prosten and potosin (sp?) used all three v-bacs to go into labor. Even a week after by due date, my dialation is 0 and my cervix isn't even thinned. My first two were so overdue that they were each over 10 pounds as well. Now no one will used any inducing methods on anyone who's ever had a c-section. I don't want a c-section, but had tried 3 OBs and they all recommend against inducing.

Is there anything I can use to prepare my body to go into labor without the Dr, so I can just go and deliver instead of being forced into a c-section?

Thanks for any insight!

I am a Monkey's Mama said...

I've been meaning to forward this article to you, especially knowing that it is from your own backyard. The mom in the article is an ICAN Mom, and has shared with us that the article was completely changed after her repeat c/s rather than vbac.

I've already written a letter to the editor and the writer, but of course have heard nothing back....

So sad to think that women who don't read the comments section are going to think that 50% of all vbac at home end in a dead baby.

It all just makes me sick.

Permission to Mother said...

I sent my letter to the editor and reporter also.

I got a request to edit to less than 300 words, which I did, and they would print. It was hard to make the cut and retain the meaning.

I am not good at reading print newspaper daily. Someone please be on the look out for it. I imagine they will edit it furthur or put a non-accurate headline to it.

I tend to shy away from being involved with the paper. Reporters are far from experts. They only want sensational news. The deadlines are tight and information not accurate. Our local paper will do anything to make our hospitals look good--our hospitals pay for the advertising.

Permission to Mother said...


I sent you a private e-mail that requested you to call the office because of your request for individualized medical help.

Since you asked about things you can do at home to induce labor... I hope you don't mean herbs and homeopathics. They are far to dangerous, especially when chances are your OB wouldn't be familiar with them and can compound the dangers with the pharmaceuticals they give you. My Herbal Induction article is on my main website

I read your profile. You say you trust the Lord for your adoptions. Have Faith in birth, too!

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