Comments on: ACOG on VBAC: In Their Own Words

By: Rachel

Rachel — Tue, 29 Jun 2010 18:09:45 +0000

Yep, I believe the author is talking about “safe” for providers (legally).

By: Bonnie

Bonnie — Tue, 29 Jun 2010 17:38:20 +0000

The fact that this doctor whom some have seen as reasonable and kind can say that it might be : “Any time we are tempted to take the safe path but not the righteous path,”It would be better to take the righteous one.

So, does he mean the safe one would have protected HIM and other O.B.s? He must. Because any well educated childbirth proponent knows that it is NOT as safe to have a C-section as a vaginal birth.

All this horrible induction and counting the days past an IMAGINARY due date is just plain wrong.

Let nature take it’s course.

That could not possibly be worse for women (or their babies) than the over medicated births that the USA is providing these days.

By: Donna

Donna — Tue, 29 Jun 2010 16:36:07 +0000

In one of the articles which led me to this blog, the author stated that VBAC is commonly perceived as risky, and that we needed to think outside the box on this issue.

I worked with Bruce Flamm’s research on the safety of VBAC in the very early 90s, and from there the medical evidence has not wavered much. Anybody who looks into objective stats about safety of VBAC should come up with numbers which support trial of labor. As a childbirth and VBAC instructor at a major LA hospital, my feeling is that the perception of risk is propagated by the MDs themselves, because I have read next to nothing that touts VBAC as any more dangerous than repeat C, and most reports say it’s safer.

I have students whose MDs tell them that they are risking their babies’ lives by wanting a VABC. I have students who have to change MDs two or three times in their pregnancies to find a doc who is supportive of VBAC. I have students whose MDs schedule a repeat C for them but tell them that they support VBAC. I have students whose MDS tell them they can have a VBAC, but only if they go into spontaneous labor before 39 weeks…if not, they’re scheduled for a C. We have an MD who had two VBACs herself and tells her patients, if I knew now what I knew then, I’d have had repeat Cs. (Needless to say, I no longer refer people to this doctor as VBAC-friendly!)

All that being said, and reading the above comments, when I try to put myself in the OBs’ shoes, and with all the info I’ve read about the anguish and even ruining of careers, marriages and lives that can come with lawsuits that drag the MD through the mud and back, in my heart I can understand defensive practice, and the truth is that nobody seems to sue for doing an unnecessary C, but plenty of people sue for not doing a necessary one.

By: Rachel

Rachel — Mon, 21 Jun 2010 15:17:06 +0000

Melissa, that’s exactly how I read the author’s statement, too.

By: Melissa

Melissa — Mon, 21 Jun 2010 15:14:19 +0000

Could the “safe” path be referring to what’s most likely to not result in a lawsuit rather than what is safest for the woman and her baby?

By: Rachel

Rachel — Sun, 20 Jun 2010 18:13:39 +0000

Hey, Susan, thanks for your comment/clarification about the “two ACOGs” – this is bound to cause some confusion going forward given the identical abbreviations.

By: Susan Jenkins

Susan Jenkins — Sun, 20 Jun 2010 16:34:32 +0000

I, too, have read Dr. Scott’s editorial and Dr. Waldman’s address and feel encouraged. I want to point out to everyone reading this blog, however, that there are now two ACOGs. ACOG split recently into two entities, a 501(c)(3) educational entity to continue with the name American COLLEGE of Obstetricians and Gynecologists, and a separate trade association, American CONGRESS of Obstetricians and Gynecologists, which will be the lobbying arm. Sort of good twin/evil twin — or good cop/bad cop.
Dr. Waldman, the let-us-reason-together guy, is the president of the College twin, the twin that recently reached out to ACNM to work together on finding ideal collaborative models. He sounds pretty reasonable and I hope something good comes of that. But notice that the evil twin, ACOG the Congress, just last week — as Dr. Waldman’s letter was circulating on the internet — was lobbying against the bill that would allow New York midwives to practice without those anachronistic anti-competitive written practice agreements, just as it has lobbied against autonomous midwifery practice in Massachusetts. Since Dr. Waldman practices in New York State and has midwives working in his practice, it would be interesting to hear his take on the position that ACOG the Congress has taken on the New York bill.
Thanks for this opportunity to warn readers of this great blog that, from now on, when you read or hear about ACOG, double-check on which tricky twin is speaking or being spoke of.
Love to all at OBOS from the Big Push for Midwives Campaign.
Susan

By: Rachel

Rachel — Thu, 17 Jun 2010 17:42:09 +0000

Thanks for your comment, Kendra. In the context of the full piece, I believe the author was saying that the physician’s impulse to do cesareans just to be “safe” may not be the “righteous” choice, but I can see how that might be unclear because it doesn’t clearly tease out the difference between a provider’s perception of safety vs. actual safety for the woman.

By: Kendra

Kendra — Thu, 17 Jun 2010 17:32:30 +0000

It’s a start, but this bothers me tremendously:
“Any time we are tempted to take the safe path but not the righteous path”???

For most women, vaginal birth is both the safe AND righteous path. According to the WHO, a “safe”, do-no-harm cesarean rate is 15%. Maybe he means *safer* from lawsuits? How about not to electively induce or perform an elective cesarean. (period! and lose the “prior to 39 weeks” addendum) That would help quite a bit toward the previous recommitment of not performing unnecessary surgery! Since when did the timer start to ding at 39 weeks?

OBs should look to take the “patient” path – both in looking to their patients’ rights and cues, and also in figuring out when the best thing to do is to sit on their hands and wait!