VBAC vs ERCS Study

Kathleen Doheny from HealthDay News reported last week on the Annals of Family Medicine study (full text pdf), Vaginal Birth After Cesarean in California: Before and After a Change in Guidelines. "The number of women who gave birth vaginally after a cesarean delivery has dropped in recent years, but without the expected reduction in infant and maternal death rates, a new study has found." Well, that is indeed a no-brainer for those of us who have a clue about VBAC and Caesarean risks and benefits.

As all good reporters do, she found someone to refute the evidence... there is always someone who has an expert "opinion." Dr. Richard Frieder, an obstetrician-gynecologist at Santa Monica-UCLA Medical Center and a clinical instructor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles, said the new study has a major flaw. "It doesn't address maternal or fetal complications," he said. He is correct in this regard and goes on to add, "The main complication of VBACs is not death but morbidity, such as blood transfusions, hysterectomy, infection, heart attack, stroke, kidney failure, the baby having low Apgar scores or brain hemorrhage. All they are talking about is how many people lived or died. But they didn't measure complications. If they had looked at complication rates, there would have been a huge difference favoring c-section." Sure there are risks to vaginal birth, but saying that there is a "huge difference"... yeah right, and pigs fly. Please show me the evidence Dr. Frieder.

I have done a lot of research into this very concern and the evidence is clear. Don’t miss Childbirth Connection’s (formerly Maternity Center Association) What Every Pregnant Woman Needs To Know About Cesarean Section booklet for solid, evidence-based facts on cesarean risks.

The study concludes with, "Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision. Women with infants weighing ≥1,500 g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery." Well done doctors, now could we please lean on the idiots at ACOG to reverse their inane butt-protecting VBAC guidelines that have essentially eliminated vaginal birth as an option for most post-caesarean women in the US?