Women's
Choice of MissoulaWomen's
Choice of Missoula
Dr. Beverly Braak
Testimonials
Dr. Braak is Great. She's very approachable and willing to take the time to discuss your issues yet skilled and knowledgeable. As a nurse-it's great to have a doctor other nurses recommend and trust. Bev and her staff are wonderful-go for it guys!! Mel Blomgren
Dr.
Braak was excellent through everything! She answered all the questions we
had and was very understanding throughout the whole pregnancy. Even
when I thought I was being silly, she was
awesome.
Jessica & Baby Olivia
Education
March 1, 2010
To C-Section or not to C-Section
The Low Down on VBACs
What does "VBAC" stand for? --- Very Bad Actors Carousing? Vixens Behaving Alarmingly Coy? As most women who have had a Cesarean Section know, VBAC stands for Vaginal Birth After Cesarean.
Women's Choice or lack thereof --- Back in the day, women who had a previous C-Section were required to have a repeat Cesarean with a subsequent pregnancy. They had no say in the matter. Time passed and the pendulum swung the other way. As a resident physician in the 80's women who had a C-section in the past were not permitted to choose a repeat C-section at our hospital. All of these women were required to attempt a VBAC. And if a woman had asked for a C-section with her first pregnancy for no other reason than she wanted to avoid labor and possible problems brought on by a vaginal birth, well ......... I can't imagine what my reaction would have been except shock at her audacity to suggest such a thing.
Fast Forward to the Present --- The American College of Obstetricians and Gynecologists (ACOG for short - or The Mothership as I like to call it) now recognizes the validity of all three options - Elective C-section, Repeat C-section and VBAC. Women have more input into planning their birth experience now than ever before. So, if you've had a Cesarean section in the past what do you need to know to help decide if you want your next birth to be au natural or a scheduled surgery?
Who's a VBAC candidate? --- There are two types of uterine incisions used for C-sections. The classical C-section is an up and down incision used for very pre-term babies and some unusual fetal positions. It is much less common that the low transverse incision which is made horizontally in the lower uterine segment. The risk of rupture of the uterine incision in labor is far too high to be reasonable if you've had a classical incision. Don't even think about it. But if you're one of the 98% of women who've had the horizontal incision (or LTCS for short) you might be a VBAC candidate. (Why did Jeff Foxworthy just jump into my mind?)
If I can have a VBAC, why would I choose a C-section? --- The best outcome for mother and baby is a successful VBAC. The second best outcomes are for scheduled repeat C-sections. The most problems are encountered if a repeat Cesarean is required after a woman has attempted a VBAC. For this reason, the rationale for the first operative delivery should be considered before choosing a VBAC. If the C-section was performed because the baby was breech or the baby was not tolerating labor well, the chances for a successful VBAC are good. On the other hand, if a woman reached the 2nd stage of labor and pushed for 4 hours before finally having an operative delivery, it's quite possible her pelvis isn't built for this type of delivery..
Are VBACs safe? --- In general, the answer is a resounding YES. But do consider this - when a VBAC is in labor, the obstetrician and the anesthesiologist are required to stay in the hospital until she has delivered and an operating room must be kept available for her at all times. In the rare instance of a uterine rupture, the lives of both mother and baby may depend on how quickly an emergency C-section can be performed. Uterine rupture is not a big risk - but the stakes are high. I cannot emphasize enough the importance of laboring in the hospital if you've had a previous C-section.
Bored yet? --- It seems this section is getting a little long. I'll sign off for now. If you have further questions or comments about this issue or ideas about subjects you'd like to know more about, write me at womenschoiceofmissoula@yahoo.com.
Bev Braak M.D.
February 1, 2010
Ultrasound and Your Due Date,
The Facts and Nothing but the Facts.
You need daycare for your newborn son, Anastasia. The only affordable facility doesn't accept children under 1 year of age. Here's my first question:
Can you sneak your son in by claiming he just looks young for his age?
Of course not. Anyone can tell the difference between a newborn and a 12 month old and if they can't, you probably don't want them anywhere near little Anastasia. But suppose 14 years later Anastasia has grown like a weed standing 6 feet tall and weighing in at 210 lbs. Here's my second question:
Could you convince the average bystander your son is 16 years old knowing full well he is only 14?
Of course you could. Fourteen years ago you couldn't get away with a 6 month fib but now you can stretch the truth by several years. The reason is that such rapid growth and change takes place during a child's first year of life that it's easy to tell the difference. As the years pass, growth slows down and individual variances increase so that pinning down someone's age becomes more challenging.
The same principle applies to dating a pregnancy by ultrasound. Fetal growth during the first trimester is much faster than the remainder of the pregnancy therefore, the earlier the ultrasound, the more accurate for determining gestational age. If your first ultrasound was done at 6 weeks and estimates your due date as January 7th, another ultrasound done at 20 weeks can't move that due date up to December 30th. Your obstetrician might consider delivering you on 12/30 but only because of the tax break you get and not because that's your due date. If your baby measures 21 weeks at your 20 week ultrasound, that just means he's big for his age, not older.
And not for my final question:
Why on earth would you name you child "Anastasia"? I know it worked for Johnny Cash but honestly Mom, what were you thinking?
So to recap-The first ultrasound is always the most accurate for determining the due date.
Bev Braak M.D.