Jo,
You might want to ask them that given the incidence of placental abruption is higher than that of uterine rupture (according to some studies I read), equally unpredictable and potentially just as fatal to mother and baby why all women are not subject to CTG. My understanding is that fetal distress is often the first sign of placental abruption too.
Given that medical events such as uterine rupture and placental abruption are mutually exclusive (although rupture can lead to abruption) the risk of either cannot be added onto the other. Therefore VBAC women actually have a higher (but the same as the general population) risk of (non rupture related) placental abruption than they do of uterine rupture. And yet given that this risk (of placental abruption) is accepted for the general population why is the lesser risk of rupture not accepted for the VBAC population.
These risks do of course include the range of these conditions from a minor (non life threatening) separation to full separation (in the case of placental abruption - and the same range of degrees also occur in "uterine rupture" everything from dishesience (non life threatening) to full rupture of the upper segment. So it is not like they can use the arguement that most placental abruptions are not life threatening.
Debby
>From: "Jo & Dean Bainbridge" <[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED]
>To: <[EMAIL PROTECTED]>
>Subject: Re: [ozmidwifery] petition
>Date: Sun, 29 Sep 2002 18:45:26 +0930
>
>Dear Liz,
>I have sent you the petition via snail mail. But to answer your question about why not allow vbac...
>the multicentred study in vbac management (which only looked at one type of management) stated that with the ruptures that did occur the first signs were fetal bradycardia detected on CTG. Therefore, although there was no maternal deaths (cant remember if there was infant death but I don't think so) and the rupture rate was in fact 0.2%, they are calling for continuous monitoring for all vbacs and they are being backed by RANZCOG. Therefore vbac is no longer considered safe enough for birth centres.
>When we contacted Flinders Medical centre about their abrupt vbac policy change, they gave us that excuse and also mentioned the tragic death that did occur in SA in recent years. This was not in the birth centre and had a number of interventions that in fact caused the rupture and although these would have not happened to her in the birth centre, they seem it valid to remove the option and insist that MORE women be put in a situation where induction, augmentation, epidurals and so forth are on hand.
>MUCH SAFER!!!! not
>so there you have it. We have written back to them saying that the excuses given were invalid and irrelevant and also how reducing the options for women will in fact make them see home birth as a greater alternative (although we don't think this as a bad thing) but we have said that with the current crisis with mw insurance that women will try and birth at home unattended (not likely to happen) but the hospital wouldn't want to be associated with this situation.
>keep you posted about the outcomes when they come in. you can email me personally if you want more info. Probably should show a little decorum on the list... that would be a first!
>cheers for now
>Jo Bainbridge
>founding member CARES SA
>email: [EMAIL PROTECTED]
>phone: 08 8388 6918
>birth with trust, faith & love...
> ----- Original Message -----
> From: ec newnham
> To: [EMAIL PROTECTED]
> Sent: Thursday, September 26, 2002 9:53 PM
> Subject: [ozmidwifery] petition
>
>
> Dear Jo, I sent you an email with regard to the petition, not sure if you received it. I should be able to collect up quite a few signatures. Email me privately and I'll give you my address to send them to. Its no use emailing them to me as I don't have a printer - although if its easier, I could send you my sister's email (who does have one). Let me know. I was appalled when I heard about the sudden policy change at one of our major hospital birth centres! with no reason, no consideration, no evidence and no collaboration with the midwives who work there. WHY??????
> yours in astonished fury,
> Liz.
