Sunday, December 19, 2004

The Big New VBAC Study

This month’s New England Journal of Medicine publishes a study of trial of labor versus repeat Cesarean. It concludes that “A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low.”

How low? In an editorial appearing in the same issue, Dr. Michael Green, M.D., says “there would need to be 588 elective repeated cesarean deliveries to prevent one poor perinatal outcome [from an attempted trial of labor].” He states that, “Some people will consider the estimated 588 cesarean deliveries needed to prevent a severe adverse perinatal outcome to be a reasonable number, whereas others will consider the perinatal risks associated with a trial of labor small and well worth taking for the benefit of a vaginal delivery. Ultimately, risk, like beauty, is in the eye of the beholder.”

I confess to not having read the study results yet. But a summary in that venerable publication USA Today says that among the VBAC women, uterine rupture was much more prominent among those on pitocin (either to induce or augment labor). In the trial of labor group, the overall uterine rupture rate was 0.7%; in the women on pitocin, it was 1.1%.

And now, because I absolutely MUST be in bed by 9:00 or my spouse will accuse me of loving my laptop more than him, I throw out this one, warm and fuzzy link without much context. It’s about a recently constructed birth center that serves a largely Amish/Mennonite community in Pennsylvania. Much of its furnishings and supplies were donated by Amish and Mennonite families. Can you imagine how pretty the bed covers must be?


Blogger Sage Femme said...

"Ultimately, risk, like beauty, is in the eye of the beholder.”

This is the beef - the thing that really matters. Unfortunately, "risk" is relative with modern medicine. Nothing is discussed in terms of risk if it's what the provider wants, yet "risk" is overblown when it goes against the provider's malpractice protocols.

12:19 PM  
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