Oh no is this going to do for VBACS WHAT THE BL---- BREECH TRIAL DID FOR
BREECH BIRTHS.
I have just supported 2 women at homebirths both were Vbacs and both had
according to obstetricans CPD [based on last birth and post partum
pelvimetry]BOTH DELIVERED WELL Both their babies were bigger than previous
ie 3100-4100 at 42 weeks and 5321 compared to 4800 at 39+5 Both women were
induced with 1st labours at 40+12 and both got to fully dilated but WERE TO
SMALL.
I am glad Ididn't read this article
Here's hoping that the incidence of c/s decreases rapidily. jan
----- Original Message -----
From: Jackie Mawson <[EMAIL PROTECTED]>
To: Birthrites People. <[EMAIL PROTECTED]>
Sent: Wednesday, May 29, 2002 10:28 AM
Subject: FW: VBAC Article
> Thankyou for sending me this, Camille. To share... in frustration
> Birthing Beautifully,
> Jackie Mawson.
>
> ------ Forwarded Message
> From: "Troy and Camille" <[EMAIL PROTECTED]>
> Date: Tue, 28 May 2002 17:22:29 -0800
> To: "Jackie Mawson" <[EMAIL PROTECTED]>
> Subject: VBAC Article
>
> Hey Jackie...Here is the article from the paper. I just can't
> believe it! Our last baby was born in 2000. He was actually delivered by
> his dad on the side of the road. What an awesome birth! Now, I don't
know
> what I'll do! Hope you 'enjoy' the article! Take care! All my
blessings,
> Camille
>
>
>
>
> Spokesman Review, March 19, 2002
>
>
> Hospital forced to limit birth options
>
> Section: MAIN NEWS
> Page: A1
> Author: Susan Drumheller Staff writer
> Illustration: Color Photo
> Caption: Some surprising news. Christi Kuchenski will have her
eighth
> child in November, but it won't be delivered naturally if she has the baby
> at Kootenai Medical Center. Photo by Kathy Plonka/The Spokesman-Review
>
>
> Christi Kuchenski is expecting.
>
>
> ``This is a surprise - it wasn't something we planned,'' said
> Kuchenski, 41, who has donned her maternity clothes for her eighth child.
> Kuchenski had another surprise recently. More of a shock really.
>
> After her initial appointment at a women's health clinic in Coeur
> d'Alene, she learned she automatically would be scheduled for a
> Caesarean-section delivery.
>
> ``My mouth dropped,'' Kuchenski said.
>
> Women's birth choices became more limited in North Idaho in December
> when Kootenai Medical Center adopted a policy to no longer perform vaginal
> births after C-sections, known as VBACs.
>
> The policy was driven by guidelines from the American College of
> Obstetrics and Gynecology, hospital accreditation organizations and a
recent
> study of VBACs in Washington state.
>
> Malpractice insurance rates are among the highest in the field of
> delivering babies, giving obstetricians a big incentive to lower the
risks.
>
> National guidelines suggest that VBACS should not be performed
unless
> an obstetrician, anesthesiologist and operating room staff are immediately
> available.
>
> It's part of a nationwide backlash against VBACs, which had become
> more common in the last two decades.
>
> But with the increase in VBACs came a corresponding increase in the
> number of uterine ruptures, caused by the pressure of labor against the
> incision from the previous C-section.
>
> The recent study of VBACs in Washington found that the risk of
uterine
> rupture was highest in women whose labor is induced.
>
> If uterine rupture occurs, the baby must be delivered by emergency
> C-section within 18 minutes or risk serious brain damage or death.
>
> In women with low risk factors, such as Kuchenski, the chances of
> having a uterine rupture are about 1 in 100, or less.
>
> That's a chance Kuchenski is willing to take, but KMC's doctors
> aren't.
>
> ``We can't cut corners,'' said Dr. Frederick Ambrose, a Coeur
d'Alene
> obstetrician. ``Continuing to do VBACs put us in an untenable situation
from
> a risk standpoint. We felt we were putting babies' lives at risk.''
>
> The Midwives Alliance of North America has voiced concern that the
> recent study, published in the New England Journal of Medicine in July
2001,
> will undo decades of reform efforts to debunk the old medical adage that
> ``once a Caesarean, always a Caesarean.''
>
> ``This is not a simple issue,'' warns Joe Bujak, vice president of
> medical affairs at KMC. ``The community is as much a part of this dynamic
as
> much as anything being unilaterally done from inside the medical
> community.''
>
> For instance, medical malpractice insurance has skyrocketed for
> obstetricians, he said; ``Perfection is an absolute standard. You can't
have
> a bad outcome.''
>
> Last year, a Spokane jury ordered Deaconess Medical Center to pay a
> woman $850,000 after her baby died from a uterine rupture during a VBAC.
>
> Deaconess still allows VBACs, but only if the obstetrician is
willing
> to be on the hospital campus during the duration of the delivery. Sacred
> Heart Medical Center has a similar policy.
>
> Both hospitals are large enough to have an anesthesiologist and
> operating room staff on hand around the clock.
>
> But KMC is smaller, and Kootenai County only has seven
obstetricians.
>
> ``To put an operating room crew on call, an obstetrician on call in
> the house, all the time, and an anesthesiologist in the hospital all the
> time, that's a huge expense for something that might happen two times a
> year,'' Bujak said.
>
> KMC has not yet had a bad outcome with a VBAC, according to the
> hospital's risk manager. But once the American College of Obstetrics and
> Gynecology released its latest position paper on the subject, that made
the
> procedure riskier, from a liability standpoint.
>
> ``If you choose to do them, you're climbing out on a limb,'' Bujak
> said. ``No one wants to climb out on that limb, because it gets skinnier
> every year.''
>
> Kuchenski and her husband, Bob, live in a spacious, spotless home in
> rural Kootenai County, about a halfhour north of Coeur d'Alene.
>
> Two of her children have been delivered by midwife. Her best
> experience was when Aaron, 7, was born underwater in a Northern California
> birthing center.
>
> ``It was really good,'' she said, as she balanced 11-month-old
Robbie
> on her hip and pulled spaghetti out of the refrigerator to feed her
> homeschooled children lunch Monday.
>
> ``It's kind of ridiculous,'' she said. ``You want to make a wise
> decision. I don't want to give birth at home. I'm too far away from a
> hospital.
>
> ``But for me, a Caesarean is not a wise decision, because the risks
> are too high.''
>
> The risks from C-sections include infections and complications from
> anesthesia that can harm baby and mother.
>
> Kuchenski's last child was delivered by C-section because her water
> broke early but labor did not follow, even with labor-inducing drugs.
>
> ``I felt I lost two months of my life because I couldn't do
> anything,'' Kuchenski recalled. ``With natural birth I'm up walking out
the
> door after six hours. It's really hard to take care of a baby when you're
> trying to recover from surgery. I got out of the hospital and I just cried
> and cried.''
>
> Some doctors worry that the new policy may prompt determined mothers
> to deliver by lay midwife at home, when they should be in a hospital.
>
> ``Home-birth midwives, if they're smart, will only take low-risk
> clients,'' said Cathy Weston, a Coeur d'Alene midwife.
>
> Weston said that the highest risk of uterine rupture are in cases
> where labor-inducing drugs are used - an opinion that's backed up by the
> study of Washington state mothers.
>
> Weston said she has about one VBAC delivery a year.
>
> ``You have that `what-if' factor, but you have that any time when
> you're driving down the road,'' she said. ``People should have the option.
I
> think it's terrible that it's fallen on such awful ground.''
>
> A partial solution may be to perform fewer C-sections in the first
> place. Now, about 20 percent of babies delivered at KMC are delivered by
> C-section, which is slightly lower than the national average.
>
> Some C-sections are prompted by indications of fetal distress, which
> may or may not necessarily be accurate. Doctors often play it safe and
> perform a C-section.
>
> Other C-sections are the result of healthy babies growing too large
to
> be delivered naturally. Still other mothers will choose to have a
C-section,
> because they don't want to undergo the pain and difficulties of labor.
>
> ``The issue is as much a social issue as a medical issue,'' Bujak
> said. ``Sometimes medical science ends up trying to sell all the things we
> can do. You generate expectations and expectations run away, and before
you
> know it, you never can get the genie back in the bottle.''
>
> Kuchenski is undecided about what she'll do. She plans to meet with
a
> doctor in Spokane and may deliver there.
>
> ``My biggest concern is that women need to be well-informed about
the
> risks of each,'' she said. ``They need to be given a choice. They weren't
> going to give me a choice, and that's not right.''
> ${Note: }
>
>
>
> ------ End of Forwarded Message
>
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