Posted on 12/04/2004 6:48:51 PM PST by neverdem
To the Editor:
Re "Trying to Avoid 2nd Caesarean, Many Find Choice Isn't Theirs" (front page, Nov. 29):
I do not believe that the issue of whether a vaginal delivery can or should be performed in a pregnancy after a prior Caesarean should be framed as a matter of a woman's right to choose.
It is perfectly reasonable for a hospital or a doctor to decide not to offer this service because it is felt to be too risky and the patient who desires it would be better served in a tertiary care center where obstetric complications are more routinely handled.
This strategy is not the same thing as pushing everyone into unnecessary surgery for the sake of profit.
There may well be too many C-sections performed, but a 1 percent risk of life-threatening uterine rupture should make practitioners and patients cautious.
Further, there are two lives at stake in this situation. The percentage of babies injured after a ruptured uterus may be low, but emergency C-sections performed after risky vaginal deliveries are certainly not risk-free.
Marc Siegel, M.D. New York, Nov. 29, 2004 The writer is a clinical associate professor of medicine, N.Y.U. Medical School.
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To the Editor:
The decision to have a vaginal delivery after Caesarean, or VBAC, should be made like all other medical decisions: on a case-by-case basis.
Surely, not all women who have had prior C-sections are at the same risk of uterine rupture, and women who are deemed to be low risk should have the opportunity to try a normal delivery.
I can think of no other instance in which a person is forced to have surgery; why should childbirth be any different?
Jill Gurvey Las Vegas, Nov. 29, 2004
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To the Editor:
As a pregnant obstetrician-gynecologist, I agree that in rural areas, vaginal birth after Caesarean would not be appropriate in the absence of staff doctors to perform an immediate C-section if necessary.
Locally, however, in well-equipped New York City hospitals, VBAC is a safe option, and I will continue to offer this valuable choice to women. My patients are extensively counseled and well informed regarding the risks and benefits of VBAC versus repeat C-section.
Deborah Gahr, M.D. New York, Dec. 1, 2004
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To the Editor:
As a mother of two who failed in her attempted vaginal birth after Caesarean, I don't regret my C-sections, as I ended up with two healthy boys. But the risks of VBAC should make doctors and mothers-to-be more aware of and vigilant against unnecessary C-sections for first babies.
Teresa O'Halloran Eau Claire, Wis., Nov. 30, 2004
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To the Editor:
I was lucky enough to give birth to my daughter in July at a wonderful small hospital where the practice is made up of four certified nurse-midwives and two ob-gyns.
I say "lucky," though really, I was strategic and resourceful, two qualities every pregnant woman must have these days to achieve a nonmedicated birth.
I chose this hospital over another in the area because it has a lower C-section rate and a reputation for taking a watchful, hands-off approach during a normal labor.
I did manage to have a medication-free birth, even though I was in active labor for 24 hours.
I am sure that if I had been at another hospital, I would have been urged to take a drug to speed up my labor or to have a C-section.
A midwife friend told me about the "cascading effect of intervention": one procedure makes the next necessary, and before you know it, you're having a C-section.
Now, if you do have a C-section, at many hospitals you've just signed away your ability to try a vaginal birth next time.
When will hospitals learn what women in labor need: a quiet, knowing presence, paying attention, giving calm advice and otherwise leaving us alone?
Emily Bloch Amherst, Mass., Nov. 29, 2004
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To the Editor:
I, too, thought I had missed out when our first child was born by Caesarean section, so I opted for a vaginal birth after Caesarean for our second.
After a long labor, my uterus ruptured, our daughter's heart rate dropped precipitously, and I was rushed to the operating room (my husband was not allowed in).
I had to endure what seemed an eternity wondering if our baby was alive while doctors worked to save us.
Our daughter needed to be resuscitated at birth, and I required a blood transfusion and a hysterectomy.
I was unable to hold her for the first day of her life.
She is almost 8 now and very healthy. We are fortunate that her traumatic birth did not cause long-term health problems. This could have been avoided if I had opted for a C-section.
Maureen A. Brady Buffalo, Nov. 30, 2004
I was offered this option. They tried to induce me and I ended up having an emergency C-Section. I nearly died and so did my child.
I don't understand the point of this article. Should I have had a uterine rupture to insure a VBAC?
My first was natural. The last two were C-section. Small woman, small hips large husband, there you go.
I get ticked with people who think it is politcal or moral, as you said. It's a health issue for mom and child.
I thought the point was evident in the linked article. Because the rate of uterine rupture during VBAC, 1%, was twice the rate they had thought it was, 0.5%, and the need to be prepared for emergency surgery was 24/7, many obstetricians, anesthesia folks and hospitals don't want to risk that emergency.
I was induced twice with my daughter. I had contractions for 12 hours with no dilation on the first day. They stopped it at 6 pm to let me sleep and then started it again at 6 am the next morning. At 2:30 in the afternoon of the second day my daughter went into distress and they had to do an emergency c-section. After all of that time, I only dilated 2 cm. I was furious that they made me go through that second day when it was obvious on the first day that nothing was going to happen.
My rate of rupture was 90%. Pardon me for asking.
Women who are able to birth without complications are blessed to my mind. I had 36 hours of hard labor with my first and then the other two were C's.
TG my OB was one of my best friends with my last. She stepped in and sent me to the OR before I ruptured and bled to death.
The point of the article is the large number of unnecessary first birth cesaereans brought on by the legal tort industry, and the costs and risks these impose upon women and the medical system.
20% of live births do not need to be via cesaerean.
Hermann, you have opinion about everything and I share none of them with you. When you birth a child, come back to me.
Yes, they are. I have a friend who was in labor for two hours with her third child. She went home from the hospital the next day and took her older children out for a walk. I couldn't believe it.
I cannot even imagine 36 hours of labor. And you were very fortunate that your OB was personally interested in you with your third child. I'd hate to think of what would have happened if she hadn't been.
A difficult issue. There are, of course, also risks associated with a c-section, which is major abdominal surgery.
I have seen both sides of the VBAC issue...a colleague induced for a VBAC experienced uterine rupture (due mainly to hospital negligence -- long story, big lawsuit $$). The child was seriously damaged. Induced VBAC's are becoming a thing of the past as they can lead to stronger contractions and a higher risk of rupture.
On the other hand I personally had two uneventful VBACs of 9 lb.+ babies after my second child was born by C-section (that one was almost a 10-pounder, born at 38 weeks!). I am very grateful that the option was open to me. The recovery time from a C-section was no picnic for me, although of course I would have done it again if I had been convinced of the necessity in my case.
My mom had my brother in the elevator on the way to the Delivery room. I was ready to kill myself after 24 hours of pushing. They finally gave me pitocin and eldest was born in about 20 minutes after.
You are right about my OB. She made sure to deliver my youngest on what was her day off (she had two year old twins at the time) because she had promised me. She was pale when she told me how strained my old scar was. I was only hours away from rupturing.
I had been on magnesium for three weeks already and the baby was still three weeks early.
You're very lucky. And I bet you'd do it all over again if you had to because you got the best reward in the world for all of that pain.
My daughter was born with a midwife in our bedroom. My wife exercised, ate well and we did LaMaze together. Six hour labor. I think c-section is like many medical procdeures: they become necessary because there was inadequate preventative means used to avoid the condition, and prevention is not used because the doctors are ignorant of it themselves.
Good theory. My wife and I did all of that preventative stuff, yet we had a c- section. Nothing medieval about it.
Apf
I would. All three are lovely boys. The first and the last have made me gray. Eldest was born with a cleft lip (it looked like someone knicked him with a knife) and had to have surgery at ten weeks. The middle one was fine. The littlest was in the NICU for ten days on a respirator. That was the most nerve-wracking since he was on 5lb 13oz at birth.
Men don't get it that we would walk through fire on broken glass barefoot for our babies.
Lucky you and your wife. Don't blame the rest of us for being healthy and having complications.
How are you feeling, Gypsy? Is Matthew sleeping alnight yet?
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