Monday, July 26, 2010

ACOG's Reversal: VBACs are ok now?

Just about everyone has now weighed in on the July 21st statement from the American College of Obstetricians/Gynecologists regarding their reversal of opinions of VBAC (vaginal birth after cesarean).

From Arkansas, THV reported these statements.  Their statements are in blue.  Mine are in green.

The number c-sections performed in the U.S. each year has been on the rise, now accounting for one third of all births. Doctors say preventing unnecessary repeat c-sections is one way to bring down those rates. 
Yes, this is true.  The US cesarean rate is flirting with 33%.  Wasn't just in March of this year when the National Institute of Health convened and contradicted just about every negative reference to VBAC with facts?  And what about those restrictive policies that often contribute to cesarean surgery?  Such as restriction of light foods and fluids during labor (cars need gas to do humans), staying in bed rather than moving around or getting into gravity positive positions to facilitate and enhance labor/birth?  Induction of labor with an unfavorable Bishop score and no signs of labor AND no signs that the baby/mother are in distress?
According to the journal, 60 to 80 percent of women who've had up to two previous c-sections, are appropriate candidates for natural delivery.
Despite our best efforts and most current technology, the maternal morbidity/mortality rate in the US continues to climb.  Why did it take so very long for ACOG to address the research?
But patient fears, coupled with insurance company restrictions on doctors, have kept the vaginal birth or v-bac rate low.
Yes, patient fears.  Anecdotally, in my own practice, it has been a combination of physician scare tactics and media irresponsibility that have contributed to my clients' fears of VBAC.  I would be curious to hear what others think here.
Some doctors have had legitimate concerns about v-bac; because there can be complications like uterus rupturing; adding that multiple c-sections can put women at risk for hysterectomies, colon and bladder injuries and infection.
In the same statement by ACOG (2004) they state that "misoprostol (Cytotec) has been associated with an unacceptably high rate of uterine rupture in women with a previous cesarean delivery."  Research shows the risk of uterine rupture with Cytotec without every having given birth!  Yet, physicians and an alarmingly increasing number of midwives are using Cytotec because, apparently, it is more economical.  Uterine rupture with VBAC is 1/2 of 1%.
And Lamaze International was right in issuing caution in their statement:
"The revised guidelines acknowledge that requiring “immediately available” resources for an emergency cesarean have resulted in hospitals, insurers and the obstetric community issuing formal or informal bans of VBAC, effectively denying women access to care and choice in birth.  While this was not the intention, the “immediately available” language remains in the new guidelines, which may continue to unfairly limit women’s access to VBAC. "
So when it all shakes out, what does all of this mean?
It means several things, clearly.  
We advise expectant parents to READ, LEARN, and READ some more to get a clear and distinct picture of the research and evidence.  Investigate as many sources as possible during your nine months of preparation for your baby: your physician or midwife, your childbirth education classes, friends, books, and the internet.  
Secondly, we URGE childbirth educators to teach evidence-based information in an easy-to-understand format to support all (regardless of age or education) women to make informed decisions about all aspects of the pregnancy/birthing process.

No one will take better care of you than you!  And no one will take better care of your baby than you.  Begin now!

No comments: