We have a friend who just delivered her third child after two previous Caesarean sections that followed non-progressive labors. According to a recent report in the New York Times, that blessing would not have been possible with many doctors and hospitals. For a number of reasons, many hospitals are refusing to allow patients to attempt VBAC's (vaginal births after Caesarean).

The largest factor in the restriction is undoubtedly fear of lawsuits. Another is an observed increase in the number of cases of ruptured uterus in recent years. What the otherwise excellent article does not mention is changes in obstetrical practice that may have contributed to the rise in uterine ruptures, such as interference with the natural process of labor (e.g. unnecessary anesthesia and augmentation of labor), and use of single intead of double rows of sutures when closing the Caesarean incision.

Women are not giving up without a fight. They give birth at home, or wait until the last minute (or later) to head for the hospital, or even labor in the hospital parking lot to avoid being forced into a c-section. Dr. Cherouny, of the University of Vermont, tells hospitals, "You must be ready. Even if you don't want to do VBAC's, you will. The patients will make you."

Because the risks to both mother and child are elevated after a c-section, no matter whether the subsequent birth is by VBAC or repeat Caesarean, it is critical that freedom of choice be preserved. Mothers, fathers, doctors, midwives, and hospitals must work together to make intelligent, informed decisions that are right for each individual family.

To view the entire article, you must register with the New York Times, but it is free and worth the effort.

Here is part of the story at the Seattle Post-Intelligencer where you don't need to register.

And here is a good overview of the risk factors associated with VBAC's.
Posted by sursumcorda on Tuesday, November 30, 2004 at 1:58 pm | Edit
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