VBAC Bans

I never thought it would happen here, in this amazing, theoretically evidence-based land where we have the priviledge socialized medicine. Maybe I was feeling smug in my theory that given SOGC's lukewarm support of VBAC (vaginal birth after cesarean) and their stance on patient choice caesareans, we would have protection from the rampant VBAC banning hospital crisis in the US.

Not so. The Red Deer Regional Hospital Centre in Alberta has announced that they will not allow VBAC trial of labour after January 1, 2006. What the hell? Does this hospital not realize that a caesarean section is riskier for mothers and babies than a vaginal birth? Do they realize that they cannot legally do this as it infringes on a mother's right to have a normal biological event, even after having a surgical event to extract a previous borne?

I find it ironic that this week a new Canadian study titled Severe Maternal Morbidity in Canada in the CMAJ/JAMC shows clear evidence that the rising caesarean rate has a lot to do with the maternal morbidity risks:

"The most common complications were cardiac arrest or cerebral anoxia -- lack of oxygen to the brain -- after obstetric surgery. There were 2,677 cases, and 37 deaths."

"The rate for uterine rupture increased from 0.58 per 1,000 deliveries, to 0.74 per 1,000. In all, 1,898 women had a ruptured uterus, and four died."

Hmm, 0.014% risk of maternal death from ONE cesarean risk or 0.002% risk of maternal death from a UR, the only VBAC specific risk. Now if we stopped induction/augmentation for VBAC mothers, a proven and huge risk factor for UR in all women, that UR rate would fall back to even lower rates. That does NOT include cesarean risks like...

"... blood clots in veins, respiratory distress syndrome, swelling in the legs, heart attack and severe hemorrhage requiring a hysterectomy [which have] increased 50 per cent or more over the 10-year period."

So, the RDRHC wants to set a precidence. Not without resistance, believe me. I am working on the fuel right now to counteract their VBAC fears, but it likely won't be pretty given that they are investigating a local midwife who does many VBACs, with excellent success I might add. Why do mothers have to combat the fears of physicians when working through their own fears in preparation for their upcoming birth? Welcome to "modern day obstetrics" where birth has been so screwed up by well meaning physicians they are chasing their tails and only traditional midwives can see the truth and light of this normal physiological process.

PS. Is it ironic that this week we have also seen a VBAC mother deliver her baby on the roadside enroute to the hospital because her local hospital didn't allow VBAC TOL. Not to mention, a US hospital (hopefully one of many) who are reversing their decision to ban VBAC TOL because, "choice should not be taken away simply because of potential lawsuits." Can I say something? DUH!!!