VBAC: First, Do No Harm

I just spent the first part of this week at the National Institutes of Health VBAC Conference in Bethesda, Maryland.  If you you’ve read a newspaper or listened to NPR in the past couple of days you may have read about the conference panel’s major finding: that the medical evidence suggests most mothers who have had a cesarean should be able to safely deliver their next baby vaginally. This is BIG news because, as most mothers who have had a c-section know, currently less than 10% of mothers in the United States are having VBACs (a severe decline from nearly 30% in the mid 1990s). And if the reasons mothers are being denied or encouraged not to do a VBAC are not medical, then what’s up?

I put this “what’s up?” question to the test with my two home birth boys, ages nine and ten at the dinner table after the first day of the VBAC conference proceedings. I told them of an obstetrican named Dr. Stuart Fischbein, well known and beloved by VBACtivists, who got up and told the NIH panel that if  the old adage “once a cesarean, always a cesarean” is now clearly not supported by evidenced-based science then the innumerable hospitals who deny VBAC and doctors who will not support women to have VBACs are violating the doctor code of ethics, “First, do no harm.”

Jacob was the first to jump in. “You mean after they cut a mother open for one they are cutting her open again? That’s really scary.”

Aden: “Will the moms die?”

No, most will not, but they can have alot of medical complications for life, especially when you have more than one cesarean.

Jacob: ” Like what?”

Massive hemorrhage, bloodtransfusions, injury to bowels.

The boys simultaneously gasp.

Jacob: “Why are moms even using doctors? Just go to the midwives.”

Aden: “Yeah, midwives would never do that.”

It was pointed out that women who VBAC most successfully are usually in the care of midwives and family practice doctors, although there is no strong scientific evidence to support this.

Aden: “Why don’t doctors help moms not be cut?”

You see, there are these guidelines from the American College of Obstetricians and Gynecologists (ACOG) that say a hospital must have emergency services “immediately available” in case an attempted VBAC has problems and many hospitals say they cannot meet that standard.

Jacob: “What kind of complications?”

The mom’s uterus could rupture and she and the baby may die or be injured.

Another gasp.

Aden: “How many moms does this happen to?”

Less than 1 percent. Not a very high chance.

Jacob: “Wait. Let me get this straight. They are HARMING moms because practically nothing will happen?”

You could say that.

Aden: “That’s wrong!”

Jacob: “Totally whack.”

It’s a human rights abuse, really.

Aden: “What’s a human rights abuse?”

It’s when someone is being harmed for no good reason.

Jacob: “Oh yeah, this is a human rights abuse big time!”

Aden: “I feel sorry for moms.”

Me too.

Jacob: “Can I come to the conference tomorrow and tell them about midwives and home birth?”

This is a scientific evidence-based conference. Your story really won’t matter to them.

Jacob: “I’m evidence! Evidence that midwives rock!”

Aden: “Mom, please tell the moms at the conference that we know their bodies rock, even if the doctors don’t.”

I will give them that message.

 

PS: as you can imagine with my play’s popular mantra “My Body Rocks!” my boys have it ingrained into their minds that pregnant moms bodies rock!

PS: In general, VBACtivists were pleased with the NIH panel’s statement because it addressed, among other things, ACOG’s ridiculous “immediately available” guideline and urged them to change it. But there are so many factors affecting access to VBAC that only time will tell if we start seeing a surge in VBACs!

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