Book Review: Vaginal Birth after Cesarean by Elizabeth Kaufmann

Monday, June 15th, 2015 at 8:43 am

What would you do if you had a cesarean with your first child and just happened to get pregnant with your second child when a national push to lower cesarean rates was forefront in everyone’s mind? Your doctor says you’re a good candidate for vaginal birth after cesarean (VBAC), your HMO wants to pay less money (and is therefore rooting for vaginal birth), and societal pressure pushes you toward VBAC.

In Elizabeth Kaufmann’s case, she reluctantly agreed to a trial of labor with certain stipulations. The VBAC was successful, but the baby was delivered with forceps and Kaufmann experienced significant tearing.

Then, she wrote Vaginal Birth after Cesarean: The Smart Woman’s Guide to VBAC to keep other women from experiencing the horror of vaginal delivery.

Or at least that’s how this book seems. While Kaufmann does share some potentially useful information regarding cesarean sections, VBACs, and repeat cesareans, every page is infused with her experience and subsequent antipathy toward anyone suggesting that a woman who is a good candidate for VBAC should indeed go through a trial of labor.

Who does Congress, who does the HMO, who does the doctor think they are to tell a woman how she should give birth? Since when should medical standards or money be a factor?

But those are political topics that I won’t go into here.

The part that makes Kaufmann’s book most unhelpful to the modern-day mama who wants information about VBAC isn’t her obvious bias, though. It’s that the world Kaufmann is raging against doesn’t exist.

In 1996, when this book was written, VBAC was supported by medical policy and by insurance companies – and doctors were employing the same active management to VBAC as they were (and still are) to other vaginal deliveries. Women were being induced with Cytotec, Cervidil, and pitocin. Labors that weren’t progressing according to Friedman’s curve (an antiquated description of the labor process based on a significantly different population than today’s moms and describing labor under significantly different circumstances than either normal or currently managed labors) were augmented with Pitocin. Surprisingly (can you hear the sarcasm?), these women whose VBAC attempts were managed thus ended up with increased labor and delivery complications.

And, of course, the good people who write policies decided that meant VBAC wasn’t quite as good an idea as they’d originally thought, so they set new policies in place to make it hard to try a VBAC, much less to succeed at it.

And that’s where we’re at now.

Few women are being coerced by doctors or insurance plans into having unwanted vaginal deliveries. Instead, many women who would love to deliver normally and who have a good chance at being able to, were the natural processes allowed to unfold naturally, are being denied the possibility of VBAC.

So Kaufmann’s book is simply unhelpful. It is written to try to give women who were feeling coerced into VBAC an out – but women aren’t being coerced into VBAC these days. The situation is quite the opposite.

For those who are interested in the history of VBAC, the Well-Rounded Mama has an excellent overview


Rating: 1 star
Category: Medical/childbirth
Synopsis: Kaufmann has a chip on her should and rages against VBAC policies that no longer exist.
Recommendation: Singularly unhelpful for the modern woman interested in learning about VBAC.

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Reader Comments (2):

  1. Barbara H. says:

    The Well-Rounded Mama did a thorough job. I’ve mentioned before my friend who had two successful VBAC deliveries. Looks like she had them at a prime time, when they were encouraged but before they became so mismanaged.

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