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Anti-VBAC Study and Refutations

There was an article in Redbook magazing by Donna Haupt about a study, stating that VBACs may be more dangerous than repeat cesareans.

Letter to the Editor in Response

To counter Dr Hoskins view, the majority of maternal deaths from cesarean are not caused by the "indicating conditions" for cesarean. The three most common causes of maternal death are : from anesthesia caused difficulties, excessive bleeding FROM THE SURGERY, and post operative infection.

To counter Dr Cole, women are not delaying going to the hospital to avoid cesareans as much as they are trying to avoid unecessary and unwanted interventions that can create difficult labors and births. IVs, internal fetal monitors, restriction of food, drink and movement. The comfort measures advocated by childbirth educators DO positively influence outcome. Freedom of movement can help a baby descend properly and speed labor. Food and drink help combat maternal exhaustion. Showers and baths can relax a laboring mother speeding up labor, and helping to bring the baby into proper position.

Contrary to Dr Flamms statement, fetal monitoring has not been proven effective. Fetal mortality and morbidity rates have not improved do to this technology. Cesarean rates have gone up though as a direct result of this injudicious use of this technology. This has in turn increased maternal mortality and morbidity statistics.Dr Flamms nice little "story" about the woman who refused monitoring sounds like a fabrication. Can he back this anecdote up? Bradley mothers are not taught to refuse fetal checks by fetoscope or stethescope so my belief is that the delay in monitoring this baby was caused by physician ignorance. Most simply don't know how to monitor "by hand" anymore. I would also like to see documentation of Dr Grants "story" about the "lay midwife" who delayed hospitalization until the baby was compromised. People might be interested to learn that "lay midwives",more properly called direct entry midwives, have lower fetal and maternal mortality and morbidity stats than OBs!!

To Address "Andreas" story. Lowered blood pressure is a common effect of epidurals. Placental abruptions are often caused by pitocin. Her body and childbirth educator didn't fail her, her physicians did! The need for her cesarean was most likely created by the interventions employed by them. I am very sorry that Donna felt she was failed by the natural childbirth community. I am sorry she had to have a surgical birth. It does appear that it may have been necessary in her case.

But Donna, bashing the cesarean prevention movement is NOT going to make you feel better about what happened to you. I suggest you seek counseling to work through your feelings about this event and refrain from using a national publication to validate your birth experience. If you have questions about the necessity of your surgery, seek information, don't project your uncertainty in a negative way in a public format. This type of "venting" can wipe out all the gains we have made in the struggle to bring birth back under the control of the ones who are birthing! I know this is long, but I hope it will be printed in its entirety, along with all the other letters you have recieved on this issue! After all, this misleading article got 6 pages.

Letter to the Editor from ICAN

Inflammatory and inaccurate articles such as "Saving Babies" (October 1996) by Donna Haupt bear a great responsibility in creating the fear of birth in our culture which has helped create a cesarean epidemic. In direct opposition to the claims Haupt makes, the dramatic increase in cesarean section has not resulted in related improvement in maternal or infant outcome. Ironically, the industrialized the countries which have some of the lowest cesarean section rates also have the most favorable infant outcomes.

The author ignores massive research including years of studies with thousands of women that clearly shows VBAC is safer than repeat cesarean for most women with previous cesareans. Instead she uses emotional tactics and horror stories to increase the already existing fear of normal birth that is pervasive in our society. There certainly is NOT a problem of too many woman and doctors choosing VBAC. Quite the opposite. While studies show that 70-90% of women with previous cesareans can deliver vaginally, the last published national statistics show that less than 30% do. The largest group of cesarean sections are still performed simply because the woman has had a prior cesarean- this is no longer a justifiable medical indication. Thousands of women and their babies are being subjected to unnecessary, major abdominal surgery every year. Every major health organization has made statements to that effect, including the World Health Organization, American College of Obstetricians and Gynecologists, The Public Citizens Health Research Group and more.

However, if Haupt chooses to favor horror stories over facts, I can supply you with dozens of stories of women and their babies being damaged by unnecessary cesarean sections (including a baby who nearly bled to death at birth when the doctor severed the umbilical cord before delivery during the surgery, a child who has severe learning disabilities as a result of being mistakenly delivered by cesarean section three weeks early, a woman who hemorrhaged 10 days after her cesarean and as a result, lost her uterus, many women who suffered secondary infertility as the result of their primary cesarean sections, a woman who suffered nerve damage during surgery and was unable to walk for three months following the cesarean.... the stories go on and on...)

Haupt suggests that women are putting their babies at risk by refusing necessary cesarean sections. I have yet to meet a woman who refused surgery when she believed it to be needed for her baby's health. On the other hand, I have communicated with hundreds of women who bravely and willing laid themselves on the operating table and subjected their bodies to major surgery for their baby's sake. It is an insult and affront to the thousands of women who have given up the births they dreamed of to suggest otherwise. We have learned, however, that many times we were told the surgery was needed when it clearly wasn't. We have learned that in many cases the cesareans BECAME necessary because of the medical interventions used (such as pitocin and epidurals). We have been told that our bodies don't work, our pelvises are too small, our babies too big, etc. Many of us have happily proved them wrong with subsequent VBACs.

This article has done a grave disservice to the women planning a normal birth following a surgical delivery. Enough has been done to take birth away from women. I implore Redbook to show the positive and empowering side of childbirth with an article that supports normal childbirth.

Sincerely,
Kathleen Gray Farthing
Editor of The Clarion, the ICAN journal

I spoke with my husband, the biomedical engineer, last night about the study in question. His opinion was that it was not a very large study, and the data having to do with the incidence of complications in VBAC vs. repeat c/s was based on only 60 women (those having serious complications). He said that was not a big enough population to really say anything.

Also, he said that, since the definition of "serious" complications could change from study to study, this particular study was not very informative. BOTTOM LINE: If they just added "need for blood transfusion" to the "serious complications" list, the rate of complications would have been IDENTICAL in both groups.

While the researchers probably had the best of intentions in doing this study, as usual, the press has blown the results way out of proportion, especially compared to previous VBAC studies which included tens of thousands of women.

He did say, and I agree, that just the FACT that a study like this was "big news" means that VBAC has earned its place in modern medicine. Twenty years ago, people probably wouldn't have even gotten funding to do the study.

Well, I went and read the astract and as a research psychologist, I am incensed by the irresponsible conclusions that they drew. Paraphrased, the conclusion was that the risk of serious complications in VBAC attempts is twice as high as the risk for repeat c/s. I can tell you as a researcher that because they found NO significant differences between groups, it is TOTALLY inappropriate for them to draw this conclusion. Statistically, they should have concluded that the risk of serious complications if virtually the same, since its not a statistically significant difference. Sounds like McMahon and his pals are trying to scare women into foregoing a VBAC attempt to me.