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VBACs

Vaginal Birth After Cesarean Section (VBAC) + Repeat C-Sections: Myths vs Reality, Part Three

By and January 28, 2016 No Comments
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Interview with Dr. Jean-Giles Tchabo

In my last two posts (which you can read here and here), I talked about my experience approaching the delivery of my second child, after having an emergency c-section for my first. My OB/Gyn, Dr. Jean-Giles Tchabo was someone I found who encouraged vaginal deliveries after cesarean sections (VBACs) as an option for women in my situation, so I interviewed him for answers to common questions about VBACs.

In the first post we dispelled some of the myths of VBACs, and in the second we delved deeper into the topic with a series of reader questions around policies, and health issues. In this post, we turn our focus to issues and science involved in e
mergency c-sections.

What is the difference in terms of procedure and experience between an emergency c-section and a repeat c-section?

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Categories: Pregnancy, Birth + Family Planning, Science 101 + Mythbusting

Vaginal Birth After Cesarean Section (VBAC) + Repeat C-Sections: Myths vs Reality, Part Two

By and January 27, 2016 1 Comment
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Interview with Dr. Jean-Gilles Tchabo 

In my last post (which you can read here), I talked
about my experience approaching the delivery of my second child, after having an emergency c-section for my first.

The OB/GYN I chose for my second pregnancy, Dr. Jean-Gilles Tchabo, encourages vaginal deliveries after cesarean sections (VBACs) as an option for women in my situation. In the last post we dispelled some of the myths about VBACs, and today, we delve deeper into the topic as I pose a couple of reader questions about VBACs and repeat c-sections to Dr. Tchabo.

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Categories: Pregnancy, Birth + Family Planning, Science 101 + Mythbusting

Vaginal Birth After Cesarean Section (VBAC) + Repeat C-Sections: Myths vs Reality, Part One

By and January 26, 2016 1 Comment
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Interview with Dr. Jean-Giles Tchabo 

When I was in labor with my first baby, my regular OB had to leave and I was terrified. I trusted my OB and didn’t know this new doctor that was coming on rotation, and I didn’t want a random doctor making medical decisions that could mean life or death for my baby and I.

The hospital staff reassured me that the physician coming on rotation, Dr. Jean-Giles Tchabo, was “the best,” and had trained every doctor at the hospital. If I wanted a vaginal delivery, they said, this doctor was the one who was going to make sure I got it. I thought they were trying to placate me until my husband confirmed it by looking him up online on his phone.

But what we want and what is medically essential are sometimes different things. As I’ve written before,  I ended up needing an emergency c-section and it was a fairly traumatic experience. However, I’ve reviewed my medical files and I’m confident that Dr. Tchabo’s decision was in the best interests of myself and my son.

For my recent pregnancy with my daughter, I followed Dr. Tchabo to his own practice, and found that they encourage vaginal deliveries after cesarean section (VBAC), which something that not all practice or hospitals allow. So prior to my delivery, I decided to sit down with him and ask some questions about VBACs and repeat c-sections. Here’s what he had to say:

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Categories: Pregnancy, Birth + Family Planning, Science 101 + Mythbusting

What Your Doctor May Not Have Told You About Pregnancy Spacing

By April 20, 2015 2 Comments
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“Whatever you do, don’t do what Jessica Simpson did,” my OB told me with a look of disgust on her face. “And if you wind up with a c-section definitely don’t do what Jessica Simpson did! Her OB has got to be livid with her right now.”

I was 20 weeks into my pregnancy when my OB gave me this lecture. I’d been reading a copy of US Weekly with Simpson on the cover when my doctor walked into the room. “Getting pregnant four months after a c-section, we’re talking double the risk of fetal demise and pre-term birth, and triple the risk of uterine rupture. Promise me you won’t do what Jessica Simpson did.”

I promised, and then didn’t really give her warning another thought until the other day. I heard a story on the radio about a new CDC study that shows 30% of women space their pregnancies too close together. But what does that even mean, why does it matter and does anyone care?

For parents that are able to have kids the traditional way, pregnancy spacing is a very personal issue. Factors such as age, medical history, access to health care, wealth, family histories, partner relationships, and career aspirations all factor into the decision. But what we do know is that spacing pregnancies less than 18 months apart is more likely to lead to lasting negative health impacts for the mother and baby.  In addition to the risks my OB outlined, there are increased risks of anemia, repeated miscarriages, placental abruption, pre-eclampsia, hysterectomies and postpartum depression.

Ask any woman who has been pregnant (except maybe Beyonce, Gwyneth Paltrow and Heidi Klum) and they will tell you that pregnancy is hard. Even the easiest pregnancy puts a lot of strain on the body. A pregnant woman’s blood volume increases by 50%, as does kidney size, the uterus will increase from the size of a lemon to the size of a watermelon, while at the same time the growing fetus is grabbing every spare nutrient your body has to offer. Our bodies need time to recover before becoming pregnant again, similar to the way a marathon runner needs to rest after a big race. If pregnancies are spaced too close together, a mother’s body is too drained to properly support the subsequent pregnancy, leading to complications.

Of the 30% of women that don’t wait the recommended 18-24 months, there tend to be two distinct groups: 1. Teens, aged 15-19; and 2. White college educated married women who began childbearing after age 30 and intentionally space their pregnancies close together. As a woman who falls into the latter category (except for the last variable, my son is two) I can see the motivations for this demographic. Warnings of infertility and complications from ‘advanced maternal age’ loom heavily in the zeitgeist.  For this cohort (speaking as a focus group of one) it can seem as if we’re damned by our OBs if we don’t wait 18-24 months, and we’re damned if we’re 35 and pregnant.

But there’s another factor here that matters: The, shall we say, “surprises.”  In fact, if accidental pregnancies were eliminated, there’d actually be a 12% decrease in the suboptimal interpregnancy interval rate. Jessica Simpson’s second pregnancy falls into this category. In a quick survey of my own friends, this seems to hold true. When asked friends if they planned to conceive less than 18 months after a pregnancy the response was usually along the lines of, “we knew we wanted a second baby, but not that soon.” So it looks like there’s an issue with interpregnancy contraception as well.

Contraception between pregnancies is a bit of a fraught issue in the same way that sex after a baby can be fraught. Some, but not all, IUDs require the presence of a menstrual period before they can be inserted, which if a mother is breastfeeding can mean waiting months. Myths abound about hormonal contraceptives and breastfeeding, but studies have shown that they are safe and don’t impact milk production. There’s also the misconception that you can’t get pregnant while breastfeeding (you can, for the love of  bleep, you can). This means that it’s important for not just patients but for providers to have a frank discussion about birth control at the postpartum checkup.

Update 4.20.15: An earlier version of this post stated that all IUDs need to be inserted during a menstrual period.  Hat tip to Facebook commenter Alice C. who pointed out that many IUDs can be inserted without a period.


 

Resources:

Gemmill, A., & Lindberg, L. D. (2013). Short Interpregnancy Intervals in the United States. Obstetrics and Gynecology, 122(1), 64–71. doi:10.1097/AOG.0b013e3182955e58

Copen, C., Thoma, M. and Kirmeyer, S. Interpregnancy Intervals in the United States: Data from the Birth Certificate and National Survey of Family Growth. National VItal Statistics Report. 64:3. April 2015.

Mike Stobbe. Study: US moms typically space pregnancies 2 1/2 years apart. WTOP.com, April 16, 2015.

Smith, G., Pell, J. and Dobbie, R. Interpregnancy Interval and Risk of Preterm Birth and Neonatal Death: Retrospective Cohort Study. British Medical Journal.doi: http://dx.doi.org/10.1136/bmj.327.7410.313 (Published 07 August 2003)

Howard, E., Harville, E., Kissinger, P. et al. The Association Between Short Interpregnancy Interval and Preterm Birth in Louisiana: A Comparison of Methods. Maternal and Child Health Journal. 17:5.pp 933-939 (2012)

Shachar, B. and Lyell, D. Interpregnancy Interval and Obstetrical Complications. Obstetrical and Gynecological Survey. 67:9 pp 584-596 (2012)

Thiel de Bocanegra, H., Chang, R. Menz, R. et al. Postpartum Contraception in Publicly-Funded Programs and Interpregnancy Intervals. Obstetrics and Gynecology. 122:2:1 pp 296-303.

Bahamondes, L., Bahamondes, M.B., Modesto, W. et al. Effect of hormonal contraceptives during breastfeeding on infant’s milk ingestion and growth. Fertility and Sterility. 100:2 (2013).

WebMD. Breast-Feeding as Birth Control – Topic Overview. Updated May 3, 2012. Retrieved April 19, 2015.

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning