VBAC Safety: A Closer Look at the 2002 JAMA Study

Why the Campaign Against VBAC?
You may wonder how biased studies with major flaws get past the review committees of the medical journals. You may also wonder why the American College of Obstetricians and Gynecologists (ACOG) and prominent obstetricians endorse them in press releases and interviews. There are two reasons, one philosophical, one pragmatic.

First, obstetricians are surgeons. This means that surgery feels like the answer almost regardless of the question. The risks of surgery, if they're acknowledged at all, seem manageable while the risks of labor feel frightening, uncontrollable. As a result, obstetricians downplay or overlook the risks of surgery while exaggerating the risks of labor. In other words, "If you don't want to get cut, don't go to a surgeon."

Second, this is "spin doctoring" by actual MDs. The self-admitted motive? Reducing malpractice risk (1,10). Were obstetricians truly disinterested parties, the same doctors who argue that a woman has a "right" to choose a cesarean would be equally vocal in defending her right not to have one. But, in fact, VBAC has disappeared as an option in many communities. Nor would doctors and hospitals place illogical restrictions on VBAC. Particularly devastating in this regard is ACOG's statement that VBACs should only take place in hospitals capable of performing crash cesareans at any time and stipulating the obstetrician's on-site presence during labor (1). On that issue, Guide to Effective Care in Pregnancy and Childbirth, the authority on evidence-based maternity care, says (4):

"The probability of requiring an emergency cesarean section for acute other conditions (fetal distress, cord prolapse, or antepartum hemorrhage) in any woman giving birth, is ... up to 30 times as high as the risk of uterine rupture with a planned vaginal birth after cesarean. Hospitals whose capabilities are so limited that they cannot deal promptly with problems associated with a planned vaginal birth after cesarean are also incapable of dealing with other obstetrical emergencies."

In other words, if a hospital isn't safe for a VBAC, it isn't safe for any woman to labor there.

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