Panel Urges New Look at Caesarean Guidelines

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A panel of medical experts ... recommended steps to reverse a trend that has dismayed many pregnant women: the increasing difficulty of finding doctors and hospitals that will let a woman try to give birth normally if she has had a Caesarean section in the past.

The new recommendations came at a conference held in Bethesda, Md., by the National Institutes of Health to examine why the rate of ... VBAC ... has plummeted, to less than 10 percent from 28.3 percent in 1996. The repeat operations are feeding the nation’s overall Caesarean rate of 31.8 percent, which has been rising steadily for the last 11 years.

“We found ... VBAC is certainly a safe alternative for the majority of women who’ve had one prior Caesarean, provided that the incision was horizontal and low on the uterus ... About 70 percent of women who have had Caesareans are good candidates for trying for a normal birth, and 60 percent to 80 percent of those who try succeed.

Private midwives have success rates of 80-90%.

... for each woman, the decision involves a balancing act between the surgical risks from a repeat Caesarean and the risk of uterine rupture. Data presented at the conference indicated that both risks are very small. Over all, a vaginal birth is safer for the mother, but a scheduled Caesarean is slightly safer for the baby.

I don't know how they could have come to this conclusion given that so many caesarean babies have a trip to the nursery for breathing difficulties.

... this poses a profound ethical dilemma for the woman as well as her caregivers because benefit for the woman may come at the price of increased risk for the fetus and vice versa ... the quality of much of the data in this area was poor.

... Implicit in the document was the conclusion by the panel that VBAC is a reasonable option for low-risk women. I think that’s fabulous.

But she and others noted that doctors’ fears of malpractice lawsuits lead many to refuse to allow vaginal birth after Caesarean. One speaker mentioned a case of uterine rupture during a vaginal birth after Caesarean in which the baby died and the hospital lost a lawsuit for $35 million. In addition, some insurers threaten to raise premiums if doctors perform vaginal births after Caesareans. In Florida, obstetricians’ premiums are already about $275,000 a year ...

Melissa Maimann, Essential Birth Consulting 0400 418 448