V-BACS

Vaginal births after C-section are slowly being performed again

 
 
 <span class="cutline_leadin">HAPPY MOM:</span> Dr. Karla Maguire, an obstetrician and gynecologist at Jackson Memorial, with her patient Teresa Neira, and Neira’s children Enzo, 3, and Bodhi, 

9 months. Enzo was delivered by C-section; Bodhi, by VBAC. Maguire said it’s important to offer VBAC service, but each patient’s medical history is key.
HAPPY MOM: Dr. Karla Maguire, an obstetrician and gynecologist at Jackson Memorial, with her patient Teresa Neira, and Neira’s children Enzo, 3, and Bodhi, 9 months. Enzo was delivered by C-section; Bodhi, by VBAC. Maguire said it’s important to offer VBAC service, but each patient’s medical history is key.
DANIEL BOCK / FOR THE MIAMI HERALD

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When Teresa Neira thinks back to the day she had first son, Enzo, her voice starts breaking.

Enzo, now 3, was a breech birth — his head was not positioned to come out of the womb first when he was born. As a result, she delivered through a Caesarean section, even though she had planned to give birth naturally.

“It was a terrible experience,” she said.

Neira, now 36, felt the C-section prevented her from bonding with her baby immediately after his birth.

“It was very surgical,” she said. “They show you his face, you take a picture, you can’t hold him, you can’t touch him, you can’t breastfeed him, and then they take him away. I didn’t see my baby for four hours after that,” she said as her voice started breaking.

Neira feels the C-section created several problems for Enzo, who had problems latching onto her nipple and, because he was given formula by the staff, had trouble adjusting to her milk. It also took her about a month and a half to fully recover from the C-section.

For her second pregnancy, Neira went back to the same obstetricians and asked about having a VBAC, a vaginal birth after Cesarean. She was told that if she wanted to do that, she would have to find another practice.

“[They said] that if I wanted to do something like that, I should go somewhere else because they didn’t think it was worth the risk of basically, my baby dying,” said Neira.

Neira is not alone in facing a push toward C-sections.

The Florida Department of Health reported that in 2011, 40.1 percent of all new moms in the state delivered through Cesarean, considerably higher than the 32.8 percent national average, which includes both new and repeat moms, according to the Centers for Disease Control and Prevention.

The Florida report also indicates that 90 percent of mothers who had a C-section said it was due to their health care provider’s recommendation, and the most common reason given was having had a C-section during a previous pregnancy.

Nationally, the VBAC rate increased steadily between 1980 and 1996, peaking at 28 percent in that year. Since then, it has declined every year, according to the American Congress of Obstetricians and Gynecologists. In 2008, less than 1 out of 10 women (8.4 percent) with a previous cesarean had a VBAC.

Doctors are most concerned with a uterine rupture occurring with a VBAC, although according to the American Congress of Obstetricians and Gynecologists, the likelihood is extremely low, between 0.5 and 0.9 percent. However, if it does occur, it is an emergency situation and hospitals need to have the equipment and personnel to perform an emergency C-section.

“It becomes practically impossible to have a VBAC here in South Florida,” said Neira.

Neira talked to other mothers, who convinced her she could have a vaginal birth after a C-section. In South Florida, patients interested in VBACS can turn to Jackson Memorial, Baptist Hospital and Memorial Hospital in Broward.

Dr. Karla Maguire is an obstetrician and gynecologist at Jackson Memorial, which also offers VBACs in its North Medical Center and South Community Hospital.

Maguire, 35, delivered Neira’s second son, Bodhi, nine months ago in a VBAC delivery. She said she is passionate about VBACs and believes it is important to offer the service to patients because it means avoiding a major surgery.

“A lot of women want to avoid the longer recovery time that comes with a C-section,” she said. “With a vaginal delivery, you’re up on your feet faster, you need less pain medication, and you have less blood loss overall.”

For Neira, delivering Bodhi naturally was a beautiful and empowering experience.

“It makes you feel like super woman,” she said. “I think it’s a way of nature of preparing you for how difficult it is to be a parent.”

Maguire agrees that some women consider having VBACs because they want to have Neira’s experience of a natural birth, but stressed that not everyone is a prime candidate for a VBAC.

“It’s really important to talk to a physician to know why you had the first C-section and go through your medical history,” she said.

Dr. Rebecca Karsenti, an obstetrician and gynecologist at Baptist Hospital, is a VBAC supporter but agrees it is not for everyone.

“The pendulum has swung back and forth as far as doing C-sections versus VBACs,” she said. “In the past, 25 years ago, almost everybody was encouraged to have a VBAC, but they were letting people do it regardless of any criteria or history.”

She said that as a result of not carefully selecting VBAC patients, when complications started happening, the pendulum swung to C-sections.

“It went back to the system of, ‘Once you have a C-section, you always have a C-section,” she said, adding that the high number of C-sections being performed now is making the pendulum swing back to VBACs.

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