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Originally Posted by Sticky
One may not be happy with the results but at the fact that there is a process is what is of note.
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And if that PROCESS is in fact based exclusively on the "current medical dogma", which it is, and those of us who are educated about natural birth question all of that DOGMA, that is where the two sides will continually be butting heads.
Henci Goer, the author of Obtetric Myths VS. Research Realities is our (and by our I do not mean Freebirth, but overall Natural birth) premiere writer on this subject, and she wrote a great piece in 2002 titled
The Assault on normal birth, the OB Misinformation Campaign.
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I first realized that the assault on normal childbirth wasn't merely a series of sporadic events when I read the VBAC study and accompanying editorial that appeared in the New England Journal of Medicine in July 2001.1 I was struck by the disparity between what the study said and the accompanying editorial.2
The study analyzed data on 20,500 Washington State women with previous cesareans. Researchers found that the risk of uterine rupture during a spontaneous VBAC labor was 5/1000, the same as other studies have shown, 7/1000 with oxytocin induction, but a whopping 25/1000 with prostaglandin (PGE2) induction. The risk in women planning cesareans was 2/1000, not far off the odds with spontaneous labor. An unbiased person would conclude that PGE2 inductions should be avoided and that primary cesarean introduced the risk of uterine rupture regardless of subsequent birth route.
The editorial, however, written by a NEJM editor, hammered home the dangers of uterine rupture during VBAC and how doctors and their professional organizations were "coerced or cajoled" into supporting VBAC programs. It concluded, "After a thorough discussion of the risks and benefits of attempting a vaginal delivery after cesarean section, a patient might ask, 'But doctor, what is the safest thing for my baby?' Given the findings of Lydon-Rochelle et al., my unequivocal answer is elective repeated [sic] cesarean section." This message appeared all over the popular press.
The editorial seemed odd to me because the NEJM is perhaps the most prestigious and highly respected of the research journals. Surely a physician who had achieved the rank of editor had to know that the study said nothing of the kind.
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It is these types of arguments, lined up with personal experience (no, momma, you cannot have a VBAC) that is causing some women to say....
Then I will just have to do it myself.
USA Today did a good piece titled
Battle lines drawn over C-sections, where the claim was made by a doctor, that no one is willing to provide the middle ground so called "danger zone" in childbirth, and because of it parents are increasingly feeling the need to go it alone.
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"It sounds like it is kind of spreading, which is just a disaster," says Flamm, a Kaiser Permanente OB/GYN in Riverside, Calif., who has written extensively about VBACs.
Roebuck was lucky; her home VBAC went smoothly, Flamm says. But it's only a matter of time before one goes wrong and a baby dies because a C-section could not be performed quickly enough, he says.
Flamm urges women to "search for the middle ground. Talk to the doctor, see if they would just be willing to stick around the hospital that one day they're in labor."
"Unfortunately," Flamm says, "nobody wants to do the middle ground."
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I have a friend up in Idaho, five kids, she had her first in hospital, section for CPD, then her next three at home unassisted. Her first babe was a 7 pounder, and her next three boys were all over ten pounds. With her fifth, she was over 35 and figured she should prob go get some prenatal care and have the babe in the hospital because she was high risk as an older mom.
Her doc told her that because of her CPD - (too small pelvis) and section scar that she would have to have another section. It did not matter that she had given birth to three additional ten pound boys just fine. She told me that the doctors extreme stance made the decision for her.
She had her fifth baby at home alone, just fine.
In the UK, Australia, Canada, as well as here in the US, this is in fact the main reason moms are choosing freebirth right now. At least from surfing the chat rooms, talking to women, and watching things very, very closely, this is the sense I have of it.
And IF the Medicos are using scare tactics around the rupture issue, as outlined in Ms. Goers article, to freak the public and give docs and hospitals justification for not doing VBAC's. Well you can see where this train wreck is heading. Right into the courts. And if in American Politics, the people with the most money and the most "scientific" research win......well you can see where that leaves a few families who are on the fringe and have absolutely NO RESEARCH to back us up beyond our own anecdotal evidence. Claiming JOY during birth didn't buy me five cents worth of credibility on this site, and trying to hold it up against a mountain or medical research (even if they interpret it funny) and money and credentials....it is David and Goliath all over again.
And if as she claimed in the article, it is in fact the artificial stimulants that are tied to the recent increase in ruptures, well, she says it far better than I ever could:
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"The Cytotec review was instrumental in the FDA's decision to retract its ban on Cytotec. Interestingly, though, the grounds weren't reassurance as to Cytotec's safety.26 According to Reuters, "The contraindication and certain precautionary wording have been removed to reflect the fact that the drug is widely used to induce labor and delivery."
In other words, the FDA decided to let OBs use Cytotec because they were using it. In fact, as noted above, the package insert still details the horrific things that can happen when women are given Cytotec to induce labor, but now the list is buried on page 8, and the warning icon of a pregnant woman with a circle and slash is gone.19
In addition, the usefulness of these studies and editorials in persuading the public goes way beyond the first news splash. They can and have been recycled again and again in subsequent articles in the popular press.27
The Cytotec mêlée brought me to my next epiphany. Why were OBs fighting for Cytotec? You would think that anything with Cytotec's malpractice suit potential couldn't be repudiated fast enough, even if it did, as Marsden Wagner points out, allow OBs to practice "daylight obstetrics."28
But aside from using it as a reason for repeat cesarean—"We need to induce you because (insert excuse here), but it isn't safe to do that, so you'll have to have a repeat cesarean"—OBs have championed it. Answer: If you can establish Cytotec as the standard of care, you are protected if you get sued for using it. Unlike the real world, "Everybody else is doing it" works in the legal system.
How do we know that this isn't an honest disagreement?
Any number of factors tells us that we aren't dealing with a legitimate difference of opinion. First, when people who should know better make fundamental errors in presenting research, ignore data that contradicts their theory or misrepresent findings, you can bet it's because they have an ax to grind. Oh, I grant you that most OBs believe that birth is a dangerous, damaging business and that they and their interventions are all that stand between pregnant women and disaster, but that's a distinction without a difference. True scientists have an open mind. And we have ample evidence that obstetrician researchers and spokespersons don't.
Mary Hannah, lead author of the postdates trial, is chairperson of a University of Toronto conference entitled "Choosing Delivery by Caesarean: Has Its Time Come?"29
Michael Greene, director of maternal-fetal medicine at Boston's Mass General Hospital, who wrote the NEJM editorial on the dangers of VBAC, says of the merits of elective cesarean, "The in-laws get to use supersaver fares."30
James Scott, who assisted in preparing the new ACOG VBAC guidelines, made his opposition to VBAC clear back in 1991.31 Small wonder that the new guidelines say nothing about the risks of elective cesarean. In a telling bit of uninformed consent, they recommend only that women be counseled on the benefits and risks of VBAC.22-23
While the guidelines make much of levels of evidence, the main recommendation—hospitals shouldn't do VBACs unless they are capable of performing an emergency cesarean at any time, and an OB should be immediately available throughout active labor—is based on Level C evidence: "consensus and expert opinion," meaning of obstetricians. A Lancet editorial on practice guidelines disparagingly called developing guidelines without input from all stakeholders and a rigorous review of the evidence "Good Old Boys Sat At Table (GOBSAT)."32
Charles Lockwood, chairperson of the OB/GYN department at the NYU School of Medicine, is also chairperson of ACOG's obstetric practices committee. Lockwood has been point man in ACOG's defense of the use of Cytotec: "Misoprostol's new labeling is a vast improvement over the previous version, but it remains 'overly alarmist,'" said Lockwood.33-34
He has also defended the doubling of induction rates over the past decade. In an ACOG press release entitled "ACOG Addresses Latest Controversies in Obstetrics" he said that the increase wasn't due to an upswing in elective inductions.35 (I'll pause until you stop laughing.)
No, the real reason was that "Over the past ten years a number of excellent clinical trials have suggested that various conditions, which were previously treated by observation, are better managed by induction of labor. (There's the 1992 NEJM trial again.) He added, no doubt to prepare the public for a continued rise, that the "bona fide" reasons to induce exceeded the number of inductions currently performed.
He conveniently omitted the downsides of inducing labor. Chief among them, studies show that compared with spontaneous labor, primiparas run anywhere from half again to two and one half times the risk of cesarean section when electively induced, which means this is the risk attributable to induction itself.36-42 That he could make these statements with a straight face confirms that "ACOG's finest" deal in propaganda, not science.
If you still harbor any doubts about this, consider that ACOG elected Benson Harer president in 2001. Harer along with his confreres used his bully pulpit to promote elective cesarean on the grounds that elective cesarean is just as safe as vaginal birth and vaginal delivery damages the mother.43 Both statements are patent untruths."
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I really suggest you read the whole thing.
It truly provides a proper backdrop to this whole discussion.
Jenny