Hi all (Jackie M I am in SA in case you wondered where I'd got to). It's a pity that the authors of the NY Times didn't read the full article! I haven't read all of it. It's a retrospective study so that reduces its usefulness. Secondly it's one thing to plan a properly managed VBAC and quite another to have one where the labour is allowed to go on too long, the baby was crook to start with, or some bright spark induces the labour. In the abstract (JAMA website) it doesn't say whether the deaths were from fetal compromise and asphyxia etc caused by an overly long labour etc etc or as a result of the operation and sub-standard neonatal care ie failure to recognize infection or resp. distress. Rupture of the uterus in labour for VBAC women is pretty low (1%). Catastrophic rupture, massive shock and death is rare and can usually be prevented by careful monitoring and a quick trip to theatre at the first signs of impending rupture (but 99% don't), plus expert pre and post-op care. I can't work out why the women died, they shouldn't. I wonder how much Syntocinon or misoprostol was used, or how many were from 'anaesthetic accidents' . I've just been reading a big analysis of VBAC (http://www.world.server.com/turk/birthing/rrvbac.html). There are more than 300 reports and studies about it and many of these recommend a 'well-planned and managed' effort by all to achieve VBAC. Having skilled and competent midwifery staff who is known to the woman and available at all times seems to make a big difference in outcomes! A couple of reports show that continuity of midwifery care increases the VBAC rates. I bet the Scottish Report doesn't chat about midwifery models of care or about the woman's choice!
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