Thursday, November 18, 2004

Ounce of Prevention

This month’s issue of Obstetrics and Gynecology, the official publication of AGOC (American College of Gynecologists and Obstetricians), includes a study of non-hospital VBAC outcomes. The study concludes that VBACs should be performed in hospitals, not birth centers (nor, presumably, at home). It also recommends hospitals increase access to in-hospital care for “midwife/obstetrician teams” during VBACs.

These conclusions seem relatively mild compared to what I was prepared to see. After all, ACOG’s ethics committee was very hands-off in its examination of elective cesarean surgery. That the researchers didn’t cast aspersions on VBACs was encouraging, as was the mention of midwife/obstetrician teams. They did not say VBACs should be turned over to doctors, nor that they are unsafe no matter where they’re performed.

A few interesting numbers from the study:

1. Of 1,453 women to went to the birth center in labor, 24% (or 349 women) were transferred to a hospital during labor. Of those women, 87% (304 women) gave birth vaginally. Add those to the 1104 women who stayed at the birth centers and presumably birthed vaginally, and you get 1408 women of 1453 (or 97%) who birthed vaginally. Yay.

2. Six women in the study had uterine ruptures. Half of the uterine ruptures were in women who had had more than one previous cesarean or had reached 42 weeks’ gestational age.

This last point, as well as the overall outcome of the study, prompted the American College of Nurse Midwives (ACNM) to respond with its own statement that PREVENTING UNNECESSARY C-SECTIONS in the first place should be a top priority. A much stronger stand than that of ACOG’s ethics committee.


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