Saturday, August 27, 2005

Refusing VBAC for Liability Reasons

Via Kevin, MD, I learned about this story in USAToday titled "Battle lines drawn over C-sections." The piece describes women who were not allowed to attempt vaginal birth after C-section due to the doctor/hospital's concerns about litigation if uterine rupture were to occur. For example, "In Oklahoma, most OB/GYNs won't allow patients to attempt a VBAC because their malpractice insurance no longer will cover claims resulting from such births."

"And some women, such as Barbara Roebuck, never bother going to the hospital. Roebuck, 37, delivered four babies vaginally before requiring a C-section for her fifth, who was breech. Pregnant with her sixth, she says she saw four doctors in a futile search for one who would let her try a VBAC. Every one of them said: 'Hospital policy. You don't have a choice,' Roebuck recalls." According to the story, some women were apparently encouraged to temporarily relocate in order to have the choice of how to give birth.

As the article mentions, the incidence of perinatal death due to uterine rupture during VBAC seems to be very low, about 1.5/10,000. A very detailed evidence report on the topic is available here. It seems that this should be evaluated on a woman-by-woman basis, rather than forcing surgery on women due to potential litigation issues.

Some resources:
  • Vaginal Birth After C-Section Health Decision Guide - from MayoClinic.com
  • Vaginal Birth After Cesarean Delivery - from UpToDate Patient Information
  • Birth Choices After Cesarean Section - from KidsHealth Medical Research News for Parents
  • Researchers Advise Against Attempting VBACs in Birth Centers - press release from the American College of Obstetrics and Gynecology
  • Vaginal Birth after Cesarean - from the American Pregnancy Association, outlines risks of repeast Cesarean vs. VBAC.

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