I just heard a cousin Susan of mine went into labor yesterday. She had a cesarean. She was scheduled to have a cesarean today, a repeat cesarean because she had a primary cesarean about five years ago after a failed induction indicated by worsening preeclampsia. No similar problems this time around.
When our mutual friend called to tell me last week to tell me about our cousin Susan’s impending scheduled repeat cesarean, I had literally just downloaded Neonatal Outcomes After Elective Cesarean delivery from this month’s issue of Obstetrics and Gyneocology. This article compares elective repeat cesareans to VBACs, and includes analysis of “failed VBACs”. VBACs had the best neonatal outcomes, significantly better than elective repeat cesarean, and failed VBACS were the worst.
Our mutual friend said “Isn’t it great that her doctor gave her a referral to another doctor if she wanted to try for a vaginal delivery?” I am amazed at what a different outlook I have than other people. I guess it depends on where you get your info.
Huh? You mean he didn’t tell her she needed therapy, or ask her to bring in her husband so they could both talk sense into her? (Both stories I have heard from mothers). I try not to rant at my family, but she brought it up. I answered something to the effect of, no, I thought it was a shame that his own organization’s journal put out an article just this month that a vaginal delivery is better for the baby (we already know it is better for the mom) and he refuses to even consider “allowing” it if she remained in his practice. And, because of his refusal of care, and the implied negativity associated with the attempted trial of labor, she did not decide to try for the vaginal delivery.
Of course he should refer. Is he going to forbid her from seeking another practitioner? At least he went through the trouble of offering a specific name.
But, it gets worse. She did go into spontaneous labor. Studies, including this one, indicate that a cesarean after labor starts in a VBAC situation may be worse than a cesarean without labor initiation (of course there are a ton of confounders there). Did they let her labor? Of course not. It was the day before her scheduled cesarean. So they sectioned her. Even thought this study (and others) indicate the best outcome would have been from a successful vaginal delivery.
The most expensive outcome was for the path her doctor chose. Is that an influence? I should hope not. I am more prone to believe that people are more afraid of standing by than taking action, they are trained to do sections, the ACOG statement that they need to be there for the whole VBAC labor is a liability, etc etc. But, I would hope that that the higher health care costs associated with the repeat cesarean (especially once labor has started) combined with poorer outcomes would lead to pressures, either from the government, advocate groups, or the “free market” or private insurance, to curb this.