Howdy. I am still working on my various projects. Here’s a little update, mostly because I am excited about a few things, not that I think anyone was pining away without me.
First, I got 50 completions on my survey! In fact, the numbers are still climbing since a wonderful gynecologic oncologist I have been working with on other projects sent out an email plea to his colleagues. Thanks! I was originally hoping for around 80, but it has been incredibly difficult to even get past the office staff of most obstetricians. I am happy for 50 – 60. Analysis starts next week!
Secondly, I am happy to be working on writing two projects, including this one, the VBAC primer proposed on Birthing Beautiful Ideas. I am researching and writing the part on the “immediately available” standard. I have already written about before. I am trying not to be too overly academic about it. We’ll see how it turns out. Of course, I am still reading tons of research to write it, of course. I found this New England Journal of Medicine article (pdf) that was supposedly seminal in discouraging VBAC by looking at uterine rupture rates. It is only one cohort from the late 80s and early 90s, but it has some interesting numbers. For the fetal demise due to uterine rupture, the outcome usually brought up as the worst case scenario and the reason why VBAC should not be offered, the rate was 5.5% of all uterine ruptures. And, uterine ruptures only happened in less than 0.5% of uninduced trials of labor after prior cesarean. I do not think this is where Lyerly et al got their 0.00046 rate number for fetal death due to rupture, since they say it was from a prospective study, and I think the NEJM I link to is retrospective. If anyone has more time than me, feel free to follow that trail in various bibiliographies.
And finally, there is still stuff going on in my life outside of birthy fellowship-y stuff. In fact, I am on my way out to do that now. Wish me luck!