Sunday, March 21, 2010

VBACs, C-Sections, and Pregnant Patient's Rights, Part Two

Welcome to part two of my series on VBACs, c-sections, and pregnant patient's rights.  This entry will focus on why I'm covering this topic here on this blog, and why some hospitals have a policy banning VBACs.

Some readers may be wondering how this topic fits into the blog's focus, which is doing something every day to make our lives better through prepping, homesteading, and building our level of self-sufficiency, please consider this: c-sections are the most common surgery performed on women in the US.  We're talking half of the population who are at risk for having a major surgery, necessary or not.  This comes with the risk of severe complications, including death, not only at the time of surgery, but for the rest of the woman's life. 

Almost everyone will either know a woman or be a woman who has to face the choice of whether to have this kind of surgery.  Sometimes, it will truly be a lifesaving, necessary proceedure.  The mother's ob-gyn can absolutely provide all the reasons for having one.  As someone who was not provided ALL the facts in order to make an informed decision about medical interventions during my son's birth which forced a c-section to become necessary, I feel it is better to have all the information, both pros and cons.  An ob-gyn isn't going to give you all the cons, and the cons they do discuss, they will gloss over.

The decision to have a c-section can have implications for the rest of a woman's life.  It is something that can effect one's preparations, family size, and so much more.  And that is why I'm spending so much time covering the topic here.

Why ban VBACs?
There are three primary reasons hospitals ban VBACs:
  1. Their decision is based on severely outdated and manipulated information.
  2. They are attempting to protect the hospital from litigation.
  3. C-sections are more profitable.
The mindset that "once a c-section, always a c-section" is about 100 years old.  More recently, studies showed that the primary risk of a VBAC, a uterine rupture, only occurs about 1% of the time.  However, a study was conducted by Mona Lydon-Rochelle et al, and published in the New England Journal of Medicine in July 2001 that has been used by the American College of Obstetricians and Gynecologists (ACOG) to scare women out of attempting VBACs. 

Even though the study does not show any real statistical change from other recent studies showing VBACs to be a safe alternative for 99% of women, it has been cited by media and doctors as proving sgnificant risk to laboring women who have already had a prior c-section and their babies.  Unfortunately, there are issues with the accuracy of how the data was collected, and in some cases not enough data was collected for it to be statistically significant enough for any conclusion to be drawn.  What it did show was that an increased risk of uterine rupture is actually linked to common medical interventions, such as inducing and augmenting labor.

The study is further limited to information gathered through insurance records of hospital births only.  No data was collected from VBACs from homebirths or birthing centers.  The problem with using insurance codes to collect data for analysis is that the codes cover several conditions and ultimately do not represent only women who experienced a uterine tear during an attempted VBAC, thus skewing the results to look like this complication occurred more often than it did.  For a more thorough critique of this study, please check out the article found here.

The misuse of this study often leads to hospitals banning VBACs in order to protect themselves from lawsuits.  As this study does not actually show any increased risk over 1%, which was the same risk level used for years as evidence of how safe VBACs statistically are, one should really question, "why the change in policy?"  How can a 1% risk mean "safe" one day, and "too risky" the next? 

Hospitals often base their decisions on recommedations for laboring patients from ACOG.  The purpose of the ACOG is not to protect the health care of women, but to protect and further the careers of their membership.  ACOG is an organization that makes its decisions by consensus. This consensus is of doctors who's livelihoods depend on women giving birth in a hospital setting and plugging into the hospital and medical insurance system.  This often includes recommendations of induction with the use of Pitocin, a synthetic form of oxytocin.  The use of Pitocin results in far more intense and painful contractions than with the body's natural oxytocin.  The use of Pitocin is specifically what the Lydon-Rochelle study linked to an increased risk of uterine rupture in VBACs.

As for cost, the cost of a vaginal delivery is significantly less than a c-section.  According to an article at CostHelper, in 2008, the average cost of a vaginal birth ranged from $9K-$17K, while a c-section ranged from $14K-$25K or more, depending on location.  Labor induction (which is most always Pitocin) is at an extra cost. 

Care from a midwife, however, costs about 1/3 less than care from an ob-gyn, and is statiscally more likely to result in a lesser expensive, vaginal delivery.  Midwives often advocate for VBACs for their patients who have had prior c-sections, providing that the scar is a low, transverse scar with no jagged edges (as sometimes happens when a tear happens during the c-section).  Such a delivery is generally healthier for both mom and baby, but does not generate as much income for the hospital.  And that is, quite literally, the bottome line.

Live better, a little every day.

1 comment:

  1. Michelle Duggar has had the majority of her children VBAC. You would think if anyone was at risk of uterine rupture it would be her, given the number of pregnancies she's experienced.