The obstetricians’ professional trade organization, the American College of Obstetricians and Gynecologists, has been equally forthcoming about why it reversed its position on VBAC. Despite no change in the data, it issued new guidelines in 1998 that took a much more negative view of VBAC than the previous guidelines. A stated rationale for the about face was that “adverse events during trial of labor have led to malpractice suits.”
The desire to avoid malpractice suits doesn’t necessarily mean obstetricians don’t have a legitimate concern about VBAC. However, the logical discrepancies and inconsistencies that riddle obstetric arguments and pronouncements reveal that they aren’t, in fact, expressing genuine interest in promoting safe and effective care. Let me cite some examples.
The new guidelines recommend that hospitals not permit VBAC unless they can perform immediate emergency cesareans. This has had a chilling effect on VBACs, because most community hospitals can’t do this, especially at night or on weekends. But the general hospital population has about the same potential for an emergency in labor as the potential for the scar giving way. If it isn’t safe for VBAC labors in hospitals that cannot perform an immediate cesarean, then it isn’t safe for any woman to labor there.
Leaving aside that cesareans impose other risks that balance out the risk of uterine rupture during a VBAC, commentators on the Washington State data deemed the 1 in 3,300 chance of losing the baby during a spontaneous VBAC labor was sufficient to mandate planned repeat cesarean. The odds of amniocentesis precipitating a miscarriage fall somewhere between 1 in 200 and 1 in 400, more than ten times the risk of the baby dying from a VBAC-related uterine rupture. Yet obstetricians aren’t lobbying for an end to amniocentesis on the grounds that it is too hazardous.