Cesarean Section & VBAC cont...

The risk for placenta previa, in which the placenta implants over the cervix, causing severe bleeding and making vaginal birth impossible, increases by almost 50% with each cesarean.

The risk of the placenta separating from the wall of the uterus, causing catastrophic maternal hemorrhage and fetal death, increases by 40%.

Ironically, the only complication physicians commonly discuss with their patients is the remote risk of complete uterine rupture in labor, and only then in the context of explaining why they have to undergo another C-section!

A number of reasons are cited for this appalling rise in unnecessary surgical delivery, chief among them being the increasing use of medical interventions in what should be a perfectly normal and healthy event.

Epidural and other forms of pain relief, continuous electronic fetal heart rate monitoring, and induction and "augmentation" of labor are now standard policy in virtually all hospitals in the US. These interventions do nothing at all to ensure the health and safety of women and their babies.

The United States has the second highest neonatal death rate in the industrialized world, and ranks 41 of 171 countries worldwide in maternal deaths. The maternal death rate has actually risen in recent years, largely due to the high cesarean section rate.

Another significant reason for the rise is physician fear of malpractice claims against their insurance providers

The picture has become even more bleak in recent years, as more and more hospitals are denying even a trial of labor to those women who want a vaginal birth after cesarean (VBAC).

This is based on an American College of Obstetrics and Gynecology recommendation that all attempted VBACs take place in a hospital capable of performing an emergency c-section in a very short period of time, due to the perceived increase in uterine rupture rates for VBACs.

This effectively reverses ACOG's long-standing recommendation that all women who have undergone a cesarean should be offered a trial of labor, even though the uterine rupture rate has actually declined since the low transverse uterine incision replaced the "classical" vertical incision, and physicians figured out that inducing or augmenting labor is even more risky when used during a VBAC.

One wonders how these hospitals dare do obstetrics at all if they can't even provide they only thing they are truly useful for - providing life-saving emergency surgical delivery to the tiny number of women who truly need them! In fact, this policy begs the obvious question of why these hospitals can have such a high c- section rate, since by logical inference the large majority cannot be true emergencies.

Women who are denied access to VBAC are given the impression that they are in grave danger of death, that the risk of uterine rupture is much higher after a cesarean, and repeat cesarean is the safest option. The actual numbers tell us a far different story.

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