I remember now something that I wanted to respond to I think in the last CBSC thread (but I kept losing my post)... someone asked about the figure that is cited for success rate for VBAC (~75%)... No, that figure doesn't apply to *everyone* who's had a C (because not everyone who's had a C can go on to have a V/B)... it applies to everyone who gets to the point of having a *trial of labor*. If you don't have a TOL, you're not in this number. I've read the figure in several reputable sources (no, not just ICAN), so I believe it.
I would agree that probably not everyone is talking about the relative risks of vaginal births, cesarean births (scheduled, elective, repeat, emergency, whatever), VBAC, etc. in an adequate way. And different sources have different kinds of biases. To be honest, I think OBs downplay the risks of *all* C/B, because they feel like they are in control in a C/B (whereas they aren't, really, in a V/B), even though they may not have total control over a woman's blood pressure, her response to anaesthesia and other drugs, whether the baby squirms and gets cut while the uterus is being cut, etc.
Correlation does not equal causation. The rise in C/B and the drop in maternal mortality may be causally linked, but I'd like to see the evidence first. I think improved nutrition, less smoking, and better access to prenatal care may have *more* to do with the drop in mortality (but I don't know).
I also have to say that there are definitely different flavors of emergency cesarean. There's the crash surgery with general anaesthesia and a vertical incision, and then there's situations like mine where it was definitely urgent, but I wasn't tired out from labor (because I never went into labor!) and there was time for a good spinal and careful cutting. Part of the reason that I want to have my VBAC in a hospital with fetal monitoring is that if there *is* a problem, I'm hoping that we will be aware of it sooner and "take steps" sooner (so that if I have a repeat C, it isn't a "crash"). Some might say that I'm taking the risk of having more interventions by being in a hospital (but hey--they can't induce or augment labor), but I see it as a trade-off I'm willing to make.
One thing I keep saying over and over again is that when we weigh repeat Cs and VBAC and their relative risks, we need to include long-term stuff... quite frankly, I don't like what I know about what having the scar (and repeated cuts)... like increased complications in future pg (like placenta acreta), more adhesions, higher rates of infertility, endometriosis, need for hysterectomies, etc. I also think if you're going for a VBAC, you have to try to figure out your own odds of success and your own risks... eg, if you have a vertical incision, looks bad, if you had a prior breech, you have the highest odds for success, etc.
I think the entire atmosphere surrounding pregnancy, labor, and childbirth (V and C) should be about keeping the mama and the baby as healthy and intact as possible. Surgery is sometimes necessary, but there are things we can do in prenatal care and education and in "labor management" to minimize it. 25% is way too high a number... I think it could be safely halved without increasing maternal or newborn mortality.
I totally agree that when someone is having a V/B, she should be left alone as much as possible. I think, to be honest, that everyone would be better off if we had birthing models more like the Netherlands (where if I understand correctly CNMs deliver most of the babies and there are fewer interventions). I wish all women had access to *really good* childbirth education and natural pain coping/alleviating techniques (including water, massage, TENS/acupuncture, visualization, whatever).
I also have to say that I think that most OBs probably don't have a good understanding of natural childbirth or any of the "crunchy" stuff which just might help some women in labor and childbirth. And to be honest, I just don't understand why *so many* women are induced and augmented, and so early (I didn't really believe that it was happening, and then I checked out some mainstream boards, and I was shocked at the percentage who were doing it, and so early!). I just don't see the medical benefit to mother or child, and it costs more, and there's a higher risk that you'll end up with an unplanned cesarean.
I hope no one perceives this as being negative (especially Kim). I'm just frustrated by the current state of affairs. My scientific background leads me to really question statistics and their interpretation and the line of reasoning people use to come to their conclusions. I also am one who likes to really *see* the evidence and be able to weigh the facts so I can come to my own conclusions.