Comments on: Reactions to the New ACOG Statement on VBAC http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac Daily dose of women's health news and media analysis Wed, 08 Feb 2012 16:46:25 +0000 hourly 1 http://wordpress.org/?v=3.0.1 By: John http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac/comment-page-1#comment-3952 John Thu, 16 Sep 2010 20:02:45 +0000 http://www.ourbodiesourblog.org/?p=12157#comment-3952 I liked David's comment of 7-29-10. I have done OB for 26 years. I have seen the pendulum swing back and forth over that time. First, VBACS are safe and some states MADE you VBAC. Then they weren't so safe, and you had to have an OR crew on standby. Once they encouraged a single layer closure of the uterus, then we were to go back to a 2 layer closure. It seems we are at the mercy of the whims of the specialists at times. What's next? Maybe only specialists can do VBACS? I liked David’s comment of 7-29-10. I have done OB for 26 years. I have seen the pendulum swing back and forth over that time. First, VBACS are safe and some states MADE you VBAC. Then they weren’t so safe, and you had to have an OR crew on standby. Once they encouraged a single layer closure of the uterus, then we were to go back to a 2 layer closure. It seems we are at the mercy of the whims of the specialists at times. What’s next? Maybe only specialists can do VBACS?

]]> By: David http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac/comment-page-1#comment-3857 David Thu, 29 Jul 2010 07:34:03 +0000 http://www.ourbodiesourblog.org/?p=12157#comment-3857 I am an obstetrician at a small community hospital with over 30 years practice experience. I attended hundreds of VBACS during the 80's and 90's but have not been able to offer them for the past 10 years because of the lack of "immediate availability of emergency personnel" recommended by ACOG. Unfortunately, this most recent opinion on the part of ACOG leaves small town obstetricians and small hospitals in an impossible position. We must either provide emergency surgical capability ( which most small hospitals cannot afford to do ) or accept the potential liability associated with VBAC's in the absence of such capability or be chastised by all of the lay groups advocating VBAC for not doing so. I'm thinking it's about time for me to retire! By the way, I have seen two cases of uterine rupture during trial of labor following cesarean section in my career. I managed both at the tertiary care hospital where I once practiced and in both cases started surgery within 10 minutes of making the diagnosis. Of the four patients involved ( two moms, two babies ) only one mom survived and she needed to have a hysterectomy, many units of transfused blood and was hospitalized in serious condition for several weeks. Uterine rupture is rare but it is a very serious complication and I hope never to see another one, especially in a small hospital where it can take 30 minutes or more to get a patient to surgery. How does one truly communicate that to a woman considering VBAC? I am an obstetrician at a small community hospital with over 30 years practice experience. I attended hundreds of VBACS during the 80′s and 90′s but have not been able to offer them for the past 10 years because of the lack of “immediate availability of emergency personnel” recommended by ACOG. Unfortunately, this most recent opinion on the part of ACOG leaves small town obstetricians and small hospitals in an impossible position. We must either provide emergency surgical capability ( which most small hospitals cannot afford to do ) or accept the potential liability associated with VBAC’s in the absence of such capability or be chastised by all of the lay groups advocating VBAC for not doing so. I’m thinking it’s about time for me to retire!

By the way, I have seen two cases of uterine rupture during trial of labor following cesarean section in my career. I managed both at the tertiary care hospital where I once practiced and in both cases started surgery within 10 minutes of making the diagnosis. Of the four patients involved ( two moms, two babies ) only one mom survived and she needed to have a hysterectomy, many units of transfused blood and was hospitalized in serious condition for several weeks. Uterine rupture is rare but it is a very serious complication and I hope never to see another one, especially in a small hospital where it can take 30 minutes or more to get a patient to surgery. How does one truly communicate that to a woman considering VBAC?

]]> By: Elvira http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac/comment-page-1#comment-3855 Elvira Wed, 28 Jul 2010 20:05:19 +0000 http://www.ourbodiesourblog.org/?p=12157#comment-3855 Thank you for this list. This one has been shared a lot as well. http://www.obgmanagement.com/article_pages.asp?AID=8759&UID= In response to the first comment, what is a consumer blogger if not the "average woman"? Better yet, is there a ranking system in which some women are special or extraordinary and others are just average? I don't agree with that. Thank you for this list. This one has been shared a lot as well.

http://www.obgmanagement.com/article_pages.asp?AID=8759&UID=

In response to the first comment, what is a consumer blogger if not the “average woman”? Better yet, is there a ranking system in which some women are special or extraordinary and others are just average? I don’t agree with that.

]]> By: Rachel http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac/comment-page-1#comment-3853 Rachel Wed, 28 Jul 2010 17:44:36 +0000 http://www.ourbodiesourblog.org/?p=12157#comment-3853 Here are a couple of others that have been shared with me: Medscape: <a href="http://www.medscape.com/viewarticle/725597" rel="nofollow">ACOG Issues Less Restrictive Guidelines for Vaginal Birth After Cesarean Delivery</a> Common Sense Family Doctor: <a href="http://commonsensemd.blogspot.com/2010/07/vbac-and-home-birth-evaluating-evidence.html" rel="nofollow">VBAC and home birth: evaluating the evidence</a> Feel free to leave links to others in the comments! Here are a couple of others that have been shared with me:

Medscape: ACOG Issues Less Restrictive Guidelines for Vaginal Birth After Cesarean Delivery

Common Sense Family Doctor: VBAC and home birth: evaluating the evidence

Feel free to leave links to others in the comments!

]]> By: Amy Tuteur, MD http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac/comment-page-1#comment-3851 Amy Tuteur, MD Wed, 28 Jul 2010 01:23:55 +0000 http://www.ourbodiesourblog.org/?p=12157#comment-3851 Thanks for the explanation, Rachel. I realize that a lot of the commentary is coming from pro-VBAC activists, but they have very little power to influence anything. In contrast, I've seen several pieces on med-mal blogs instructing lawyers and those considering lawsuits that nothing has really changed. Indeed, ACOG still recommends "immediate" availability of a surgical team, the very wording that led to the restriction on VBACs in the first place. Thanks for the explanation, Rachel. I realize that a lot of the commentary is coming from pro-VBAC activists, but they have very little power to influence anything.

In contrast, I’ve seen several pieces on med-mal blogs instructing lawyers and those considering lawsuits that nothing has really changed. Indeed, ACOG still recommends “immediate” availability of a surgical team, the very wording that led to the restriction on VBACs in the first place.

]]> By: rj http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac/comment-page-1#comment-3849 rj Tue, 27 Jul 2010 16:31:57 +0000 http://www.ourbodiesourblog.org/?p=12157#comment-3849 because doctors, policymakers and average women don't have an ideological agenda... because blogs are run by aliens because doctors, policymakers and average women don’t have an ideological agenda…

because blogs are run by aliens

]]> By: Rachel http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac/comment-page-1#comment-3848 Rachel Tue, 27 Jul 2010 15:13:47 +0000 http://www.ourbodiesourblog.org/?p=12157#comment-3848 Hey, Amy, those were the ones I found when I did some initial blog/web searching for responses that included any commentary (rather than just a link to the ACOG press release or news coverage). I'm sure it's not comprehensive - I don't think it comes as a surprise that people and organizations who are particularly interested in/active about these topics were among the first to respond, but other responses of interest may exist or be written in the near future (I didn't see one from you, by the way). As invited in the post, everyone is welcome to share links to additional commentaries - from doctors, policymakers, other organizations or individuals, their own responses, etc. - in the comments here. Everybody - be aware that multiple links may get you stuck in the spam filter until we get a chance to release them. Hey, Amy, those were the ones I found when I did some initial blog/web searching for responses that included any commentary (rather than just a link to the ACOG press release or news coverage). I’m sure it’s not comprehensive – I don’t think it comes as a surprise that people and organizations who are particularly interested in/active about these topics were among the first to respond, but other responses of interest may exist or be written in the near future (I didn’t see one from you, by the way). As invited in the post, everyone is welcome to share links to additional commentaries – from doctors, policymakers, other organizations or individuals, their own responses, etc. – in the comments here.

Everybody – be aware that multiple links may get you stuck in the spam filter until we get a chance to release them.

]]> By: Amy Tuteur, MD http://www.ourbodiesourblog.org/blog/2010/07/reactions-to-the-new-acog-statement-on-vbac/comment-page-1#comment-3847 Amy Tuteur, MD Tue, 27 Jul 2010 15:04:44 +0000 http://www.ourbodiesourblog.org/?p=12157#comment-3847 I'm curious as to why you limited your summary of reactions to blogs run by laypeople with an ideological agenda. How about exploring what doctors, policymakers and average women think about the new guidelines? I’m curious as to why you limited your summary of reactions to blogs run by laypeople with an ideological agenda. How about exploring what doctors, policymakers and average women think about the new guidelines?

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