The Wall Street Journal Opinion piece.
Regarding the article “A Type of Childbirth Some Women Will Fight For” (Personal Journal, Dec. 9), not only do higher vaginal birth rates after a caesarean (VBAC) mean better overall outcomes for mothers and their newborns, but they signal how focused an institution is on delivering the highest quality of maternity care. Compare VBAC rates with breastfeeding rates and you’ll find an exceptionally high correlation because institutions focused on the highest quality of care will commit to what’s in the best long-term interests of mother and child. Hospitals that ban VBACs due to “liability concerns” shouldn’t be in the business of delivering babies. And mothers should think twice—and then think again—about using those facilities.
Sheri Matteo, CNM
As an obstetrician who champions VBACs, I give trials of labor to a large number of women with previous C-sections with much success. But the elephant in the room is the intuitively obvious fact that there are far too many C-sections done to begin with. Once a woman has the scar on her uterus from a previous C-section, the damage has been done. With the potentially catastrophic sequelae of a ruptured uterus, the physician, patient and hospital are forced to take on huge risks for a clearly better option—vaginal birth. Fewer inductions, less unnecessary medical intervention and less need to worry about unfounded lawsuits would go a long way to restoring childbirth to what it should be—a natural, beautiful experience.
Jessica Jacob, M.D.
Great Neck, N.Y.
I have been in practice 23 years and have been offering VBACs for that long. VBAC safety is the same as many obstetrical emergencies that we deal with often, such as abruptio placentae or cord prolapse. Women fail to allow themselves a trial of a vaginal birth for many reasons. Fear, the convenience of a schedule and having your own doctor, all play a role at the expense of trying, believing in your body or bonding with your baby. A repeat C-section carries more risk of infection, bleeding and hysterectomy in addition to maternal death, which although rare is on the rise with increasing C-sections.
I am perplexed about why women are willing to take far more risks daily—driving distracted, crossing the street at night without a flashlight, biking without a helmet—but don’t trust their own bodies to try for a vaginal delivery after a C-section. Maybe we all just need to slow down and remember that childbirth isn’t about a schedule; it isn’t about convenience. After all, what is convenient about being a parent?
Lizellen La Follette, M.D.
I am a retired OB-GYN physician with over 5,000 deliveries done. Though a 1-in-200 uterine rupture rate may constitute a “small but worrisome risk for some hospitals,” it constitutes a hugely worrisome risk for the attending obstetrician. Though a rare outcome, a dead baby and/or mother, or an unwanted hysterectomy goes over very poorly with the patient to whom it occurs. While it may be true that from an obstetrician’s standpoint there are no special skills in managing a VBAC, it is an extremely stressful situation for the doctor. The protocol in the hospital where I practiced required that the attending physician be physically present in the hospital when his or her VBAC patient was in active labor. This meant that if a patient arrived in active labor at 8:00 a.m. on a weekday morning, her physician might not be able to have office hours for the day, inconveniencing dozens of patients whose appointments would need to be canceled and rescheduled. While I hate to sound greedy, that’s also one day’s lost income for the physician. And from a legal standpoint, I’ll leave that to the attorneys’ imaginations.
John Elfmont, M.D.
Redondo Beach, Calif.
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