Sun 25/1//01Upon searching the NEJM Online, I found this article – I think it’s the one referred to. It has a very long address, so I would advise you copy and paste it onto your internet browser:
in the WA Sunday Times Dr Wright espoused the safety of once a c/s always a C/s based on a study form Washington Seattle published in last month's New England Journal of Medicine!
Is this the study we have discussed on this list?
If so what is the web address of the critique of it that was published on the list??
Does anyone know??
Risk of Uterine Rupture during Labor among Women with a Prior Caesarean Delivery
Lydon-Rochelle M., Holt V. L., Easterling T. R., Martin D. P.
N Engl J Med 2001; 345:3-8, Jul 5, 2001.
http://content.nejm.org/cgi/content/full/345/1/3?maxtoshow=&HITS=20&hits=20&RESULTFORMAT=&titleabstract=Caesarean%2C+cesarean%2C+c%2Fsection%2C+VBAC%2C+&searchid=1007425220516_15130&stored_search=&FIRSTINDEX=0&sortspec=PUBDATE_SORTDATE+desc+Score+desc&fdate=1/1/1990&tdate=11/30/2001&journalcode=nejm
But you need to subscribe online to read the full text (which is the address above). I will paste the abstract below. It’s address is:
http://content.nejm.org/cgi/content/abstract/345/1/3?maxtoshow=&HITS=20&hits=20&RESULTFORMAT=&titleabstract=Caesarean%2C+cesarean%2C+c%2Fsection%2C+VBAC%2C+&searchid=1007425220516_15130&stored_search=&FIRSTINDEX=0&sortspec=PUBDATE_SORTDATE+desc+Score+desc&fdate=1/1/1990&tdate=11/30/2001&journalcode=nejm
Basically it supports the findings that induced labour in VBAC women is riskier than a repeat c/section with no labour. There are studies that refute this, and I always try to encourage natural, physiological labour for any VBAC women who contact me. But the decision has always got to remain with the mother. She just needs to know the increased risks involved with induction/augmentation. Most women who contact our group choose natural VBAC labour, but if you must choose between continuuing a pregnancy that your child is not coping with, induction (with a chance of delivering vaginally) or an elective c/section, then I think the decision becomes too personal to trivialise. Don’t you?
BB Jackie Mawson.
Volume 345:3-8 July 5, 2001 Number 1
Risk of Uterine Rupture during Labor among Women with a Prior Caesarean Delivery
Mona Lydon-Rochelle, Ph.D., Victoria L. Holt, Ph.D., Thomas R. Easterling, M.D., and Diane P. Martin, Ph.D.
Background Each year in the United States, approximately 60 percent of women with a prior caesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication.
Methods We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by caesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated caesarean delivery without labor.
Results Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated caesarean delivery without labor (11 women), 5.2 per 1000 among women with spontaneous onset of labor (56 women), 7.7 per 1000 among women whose labor was induced without prostaglandins (15 women), and 24.5 per 1000 among women with prostaglandin-induced labor (9 women). As compared with the risk in women with repeated caesarean delivery without labor, uterine rupture was more likely among women with spontaneous onset of labor (relative risk, 3.3; 95 percent confidence interval, 1.8 to 6.0), induction of labor without prostaglandins (relative risk, 4.9; 95 percent confidence interval, 2.4 to 9.7), and induction with prostaglandins (relative risk, 15.6; 95 percent confidence interval, 8.1 to 30.0).
Conclusions For women with one prior caesarean delivery, the risk of uterine rupture is higher among those whose labor is induced than among those with repeated caesarean delivery without labor. Labor induced with a prostaglandin confers the highest risk.
Source Information
From the Centre for Women's Health Research, Department of Family and Child Nursing, School of Nursing (M.L.-R.), the Department of Epidemiology, School of Public Health and Community Medicine (V.L.H.), the Department of Obstetrics and Gynaecology, School of Medicine (T.R.E.), and the Department of Health Services, School of Public Health and Community Medicine (M.L.-R., D.P.M.), University of Washington, Seattle.
Address reprint requests to Dr. Lydon-Rochelle at the Centre for Women's Health Research, Mailstop 357262, University of Washington, Seattle, WA 98195-7262, or at [EMAIL PROTECTED].
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Birthing Beautifully,
Jackie Mawson.
Convenor of Birthrites: Healing After Caesarean Inc.
Visit our Website at: http://www.birthrites.org
Email: [EMAIL PROTECTED]
Phone: 61 08 9418 8949
Please note I am not a Professional Healthcare Provider, and all opinions given in this email are not to be taken as medical, or legal, advice. Please seek such advice from the relevant professional service.
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Too many Gods;
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Too many paths
that wind and
wind,
When just the art
of being kind
Is all the sad
world needs...
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