Back pattin’

I am going to take some time out to pat myself on the back a little bit. I presented a paper to our journal club today. It was a research article from the green journal about uterine rupture and vaginal birth after cesarean section (VBAC). The journal club meeting consisted of two professors, one from the school of public health and one who is a retired ob/gyn, and is the faculty adviser for our ob/gyn student interest group, and a larger group of students than we have had at any research group meeting before. (Guilt works!)

It was a great discussion. Our faculty adviser is great. Don’t get me wrong, we don’t see eye to eye on everything. His idea of reproductive choice does extend to elective cesareans and abortion, but does not extend to out of hospital birth or VBAC. Well, he has done VBACs, but that was in the 80’s when they were supported by ACOG. I think ACOG does still support VBAC, but he thinks it is too big of a malpractice risk.

We did have a decent conversation in which I got to make the point to everyone in the room that they needed a HUGE pool of births to get any appreciable number of uterine ruptures. It is such an small risk, less than 1/2 of 1% in this study and 20% of both groups were augmented with oxytocin, which has been shown to increase risk of uterine rupture. Our faculty adviser, at my request, explained the pathology of uterine rupture. I wanted the journal club group to know (despite the grisly description of the risk of neonatal death and hemorrhage in the journal article) that it is not as dramatic, in the vast majority of cases, as its name sounds. It can be a simple separation of muscle tissue, and is sometimes so asymptomatic that it is never diagnosed, or is diagnosed years later after a hysterectomy, as a side note when the tissue is examined.

I slipped in that the “success rate” of vaginal birth in VBAC trials (75%) is higher than the vaginal birth rate in most hospitals in Miami-Dade county (around 50%). And I read aloud the conclusion of the article, which states that many women might find this low rate of uterine rupture to be an acceptable risk.

Oh, and back pat #2. A friend of mine who lives in Portland, Oregon, told me that this post was read, with credit to Ms. Tinfoil Hat, on a show on Portland Public Radio, clear across the continent. Wowie, I am a blogebrity!

2 Comments

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2 responses to “Back pattin’

  1. Elizabeth

    BACK PATTING you too!
    Don’t have time to read the VBAC article…but interestingly, here in Sweden, unless there is an outright clear contraindication VBAC is the standard of care, even the OBs say they want a woman to try vaginally. (Don’t see them often, cuz midwives do all the prenatal care, and run the delivery and postpartum wards. OBs are consultant specialists and stay out of your way if it is a normal pregnancy and delivery).
    Wonder if I could get you some good Swedish VBAC data?

    as an aside home births don’t seem to be very common here, but they are allowed, but I think you have to cover some of the costs (as a VBAC i wouldn’t qualify)

    also have seen that epidurals during labor are the pain control method of last resort here in Sweden. They use supportive care, ACUPUNCTURE and TENS routinely, then nitric oxide (tho there is some discussion about reducing this, as it is a greenhouse gas).

    And YES, NPR, Blog superstar, congrats!

  2. MomTFH

    Wow, I definitely need to read up more on birth in Sweden. TENS and acupuncture, hmmm?

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