For interest. From Connie Banack (ICAN's current president).
BB Jackie Mawson.
------ Forwarded Message
From: "Connie Banack" <[EMAIL PROTECTED]>
Date: Sat, 14 Jul 2001 21:15:32 -0600
To: <[EMAIL PROTECTED]>
Subject: RE: Research Critique??
Hello Marilyn,
My name is Connie Banack and I am the president of ICAN. The study has
caused considerable debate throughout the US and even into Canada and other
countries. Their methodology brings a lot of questions regarding the 91
presumed uterine ruptures and the 5 fetal deaths found in this study. The 91
assumed uterine ruptures based on ICD-9-CM codes (who's use themselves has
been called into question) written on their discharge reports were not
looked into and the cause of the fetal deaths were not explained. I find it
odd also that it is assumed that the fetal deaths were a result of the
uterine ruptures, yet RSD from a cesarean also be a factor, or any of a host
of other factors because the cause of death is not confirmed. I would
welcome you to view the article written by our Clarion editor "Standing Up
to the VBAC-lash" regarding the true strength of this study. It is found at
www.ican-online.org
> We were all expecting the results re augmented and induced VBAC labors
> (especially with prostoglandins) but the incidence of rupture in
non-induced/augmented labors
> being 3.3 times higher than rupture in planned cesarean births is
disturbing.
> We had all been quoting the incidence of rupture with planned c/s and TOL
as
> being similar (1.0 - 1.5 %).
How wonderful that the risk is much lower for either without induction isn't
it! The results of the study were 0.16% for scheduled cesarean and 0.52% for
those with spontaneous onset of labour. The risk only goes higher with
induction and that is only minorly so when prostaglandins are not used at a
0.77% rate.
But don't be fooled into believing that because an elective cesarean is
safer than VBAC. Dr. Marsden Wagner in his Choosing Caesarean Section
article in The Lancet 2000; 356:1677-80 states, "An elective CS with no
emergency present has a 2-84 fold greater chance of the woman's death than
if she had a vaginal birth." He goes on to add, "Other risks include the
morbidity associated with any major abdominal surgical procedure
(anaesthesia accidents, damage to blood vessels, accidental extension of the
uterine incision, damage to urinary bladder and other organs). 20% of women
develop fever after CS, mostly due to iatrogenic infections. There are also
risks due to scarring of the uterus, including decreased fertility,
miscarriage, ectopic pregnancy, placenta abruptio, and placenta praevia." As
for risk to the baby, he points out, "The first danger to the baby is the
1-9? chance that the surgeon's knife will accidentally lacerate the fetus
(6% with non-vortex position)." "A much more serious risk is respiratory
distress.... The risk of RDS is greatly reduced if the woman is allowed to
go into labour before the CS. Another hazard is iatrogenic prematurity."
So the true story here is, six of one or half a dozen of the other, right?
You do have a increased risk of uterine rupture with a TOL in planning a
VBAC and an increased risk of iatrogenic morbidity/mortality due to major
abdominal surgery with a planned ERCS. Truth be told, the risk was, is and
will continue to be higher for women planning surgery than for women
planning a VBAC.
> The midwife who participated is Audrey Levine, LM and she has previously
published in this
> area also. There is reportedly an audiotape of the discussion. If anyone
is
> interested and if I can lay my hands on it I will send a copy on.
I am glad to hear a midwife did participate even though she is not listed on
the study. I would be honoured to receive a copy of the discussion, could
you let me know how to obtain one?
Connie Banack, president
International Cesarean Awareness Network, Inc. (ICAN)
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