VBAC Facts: Once a C-section, always a C-section??

Dr. Stu’s Podcast: Episode 68 – Facts R Us

Why this podcast?
If you read my post ”If it ain’t broke, don’t fix it’‘ you may remember a reference to Dr. Stu’s Podcast. That was also the first I had heard of it so a few days after writing that post I decided to check it out. Before I delve into that experience I need to go off on a sidetrack. Just a quick one, I promise!

My husband keeps telling me that I need to be more critical in my posts. Not negative but just have a few more criticisms in there for balance. I have to admit that I find that hard because, so far, I have nothing but huge amounts of bubbling enthusiasm for these podcasts and the knowledge that they bring.

However, as I pressed play on Dr. Stu’s podcast I had two thoughts. The first was ”huh???!!” and the second was, ”finally, a podcast where I can find something to criticise!”
BUT those thoughts did not last for long (well, ok, maybe the first one did). I quickly became enamored of the podcast’s unique style and could not wait to sit down and write about it!

How does it look?
Ok, back to the task-in-hand. Dr. Stuart Fischbein spent twenty-eight years delivering babies in hospitals but now practices a midwifery model of care and works with home birth midwives.

He is the co-author of the book ‘Fearless Pregnancy, Wisdom & Reassurance from a Doctor, a Midwife and a Mom’, has twice been awarded the ‘Doulas Association of Southern California Physician of the year award’ and was the first person to receive their lifetime achievement award in recognition of his support of pregnant women.

He was also interviewed as part of Ricky Lake’s groundbreaking documentary, The Business of Being Born.  I highly recommend watching this if you have not seen it yet.

At the time of writing this post, I have listened to three episodes from Dr. Stu’s Podcast and I have to say I would be very hard pressed to tell you the main theme behind two of those three. Dr. Stu is so passionate about birth that, although each episode has a topic, he tends to get a bit carried away and talk about quite a few different things each time. But you know what? His enthusiasm is so infectious that, somehow, it works!

At first, I wasn’t sure I was at the right place. I thought I had somehow stumbled onto a morning chat show on the radio.
Dr. Stu and his co-host, Brian Whitman, were like a comedy duo. They chatted away, made funny remarks, bounced off each other and somewhere along the way I realised that I was really enjoying it.

Having said that, there are times when the co-host, Brian, gets a bit carried away. His role seems to be that of a facilitator. He is not a medical professional and does not seem to know much about the birth world. His job is to be the link between Dr. Stu and his guests, to ask questions so certain things are clarified and generally be a funny guy.

At times, however, his bubbly, radio host persona gets a little bit out of control and I find myself wishing he would stop talking so that the featured guest can get a word in. Even so, I still find it extremely entertaining to listen to, not to mention insightful.

If you are looking for a lot of structured, detailed information on a specific topic this may not work so well for you. But if you want to listen to someone who is completely inspired by and enthusiastic about pregnancy, birth and a woman’s rights then this is totally for you.

It is more like listening to a chatty radio show than a birth podcast but it’s actually kind of refreshing!

Who should listen to this episode?
Although due to it’s slightly unstructured style, this episode will not give you a super detailed rundown on the pros and cons of VBAC it will be a great starting point for anyone considering either a VBAC or a repeat C-section. Also, it’s a good one for anyone out there searching for ‘their’ style of podcast. This has such a different flavour that it could be exactly what you are looking for!

The episode
I decided to feature this episode on VBAC because the choice to have a vaginal birth after C-section is one that is being made by more and more women.
Dr. Stu’s guest on this episode is Jennifer Kamel from the organisation VBAC facts. VBAC facts aims to –

”Close the gap between what major medical organisations say about post-cesarean birth options and what people generally believe

The episode starts with some discussion of a Rod Stewart concert that Dr. Stu recently attended but soon the attention is turned to Jennifer. I like the idea that Jennifer is, in fact, not a medical professional at all. She spent six years working in commercial real estate and only started VBAC facts after searching but failing to find sound information during her own pregnancy.

As I mentioned above there is a fair amount of back and forth between Dr. Stu, his co-presenter and their guests and I’m not sure that as much knowledge and information is shared as it might be during a more structured podcast. However, what this podcast lacks in structure, it more than makes up for in enthusiasm.

Jennifer begins by pointing out how pervasive the myth of ”once a C-section, always a C-section” is in our society. A myth, however, is exactly what this is.
A few facts that stood out for me during this episode were:

– The U.S.A. has a 90% repeat C-section rate

– 43% of hospitals in the U.S.A. actually have a VBAC ban

– There is a 0.4% risk of having a uterine rupture after one C-section* (spontaneous labour, no medical induction or augmentation)

– There is a 0.57% risk of placenta accreta (where the placenta attaches too deeply into the uterine wall) after two C-sections**

A risk of uterine rupture is often given as a reason for performing a repeat C-section. Jennifer, however, raises the idea that by opting for another C-section you might simply be exchanging one risk factor for another.

I think it is important to note, as Jennifer points out, that a VBAC is often seen as a procedure or some kind of intervention. What it actually is, is simply letting nature take its course and do what it is designed to do. VBAC is, Jennifer says, a

safe, reasonable and appropriate option for most women

What are Jennifer Kamel’s top three pieces of advice for having a successful VBAC?

Choose your care provider wisely.
This piece of advice is one that I see time and time again and it is key.

Create your own support system
Online or face to face meetings through, for instance, ICAN or another VBAC support group

Don’t try to educate people whilst you are pregnant.
This is a great one! Do your research. Make an informed decision that is right for you and your family. You do not need to convince others you are right.

To wrap up
VBAC is absolutely an appropriate option for many women and if this is something you are considering then this episode, as well as the VBAC facts website, are great places to start. Even if you are planning a repeat C-section it could be good to listen to this simply to get a different perspective.

I am really curious what you think of this podcast as it is just so different to any I have listened to so far. I’d love for you to leave a comment on it below!

Other episodes on this topic

The Pregnancy Podcast: Q&A – VBAC

Birthful: Episode 12 – VBAC  &  Episode BS18 – Determined to VBAC

Healthy Births Happy Babies: Episode 006 – How to Prepare for a Successful VBAC

The Birth Hour: There are quite a few pages of VBAC Birth Stories to choose from!
(I love Elizabeth Quinn’s story)

References quoted on the VBAC Facts website
* Landon, M.B. (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. N Engl J Med, 351, 2581-2589
** Maternal morbidity associated with multiple repeat cesarean deliveries (Silver 2006)

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By emilywills

Emily Wills is a doula based in Stockholm. She believes that birth can be a beautiful and empowering experience and started this blog as a way of sharing some really great podcasts. She is also a mother of three and an enthusiastic runner.

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