Posts Tagged ‘acog’

September 7th, 2010

OB’s Aren’t Listening to ACOG

OB’s aren’t listening to ACOG. While this is a huge shock for some people, it is not surprising for others. But how did I come to this conclusion?  Well, becoming pregnant put me in a position I was not comfortable being in yet. Being a woman looking for a trial of labor after two previous cesarean sections.   One that was not medically necessary at all, and one that saved my youngest son. While I believe if things had been done slightly differently the second could have been avoidable, but it was a catch 22.

In July of this year, ACOG released new VBAC recommendations in response to the growing cesarean rate, complications that are a direct result of that, the falling VBAC numbers, and the lack of access for VBAC that was all brought out in the National Health Institute’s VBAC Consensus back in March.  I was lucky enough to be able to watch the entire conference from home, and take a ton of great information from it. But it also hit ACOG hard because their representatives knew that their guideline changes essentially caused the decline in VBAC access for women Nationally.

On July 21st, ACOG made a new press release detailing some of their new VBAC guidelines, which included a statement on women with two previous cesarean deliveries.

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, “The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC,” said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

Ok, so what is the big deal right?  It says right there that ACOG supports and finds a trial of labor acceptable and essentially a safe option for women with two prior cesarean sections.

So what is the hang up? Apparently all the same OB/GYN’s out there that were quick to jump ship on VBAC when the guidelines changed years ago with new guidelines on the readiness of Anesthesia in the hospital, are NOT as quick to jump back ON the VBAC bus despite the clinical information showing it to be a safe choice.

Where does that leave me right now?

Screwed!  I have a hand full of options I am looking into at this point, but I can’t go see the midwives I was with because their backup OB practice won’t take me on… I have an appointment with a high risk Perinatology group who seems to be open to my request, but the two words high risk scare me because I know it is going to limit the availability of a natural birth. Although the positive of it all is a friend of mine, who had two home births, and came down with a horrible blood disorder during her third pregnancy had a 100% natural hands off birth with this same practice. So… I have hope…

We’ll see!

August 3rd, 2010

New VBAC Guidelines

After being so involved in the National Institute of Health’s VBAC consensus earlier in the year, I, as well as so many others were really anticipating the new ACOG VBAC Guidelines. The decline in VBAC began when they changed their guidelines suggesting only certain women, and certain hospitals were candidates for a Trial of Labor after a previous Cesarean delivery.  We saw a peak in the VBAC numbers in 1996, then a drop consistently there after.

ACOG included in their release something new that previously had been unthinkable in the medical community as a valid option for most women, and that is a trail of labor after two previous cesarean sections. Studies show that it is a safe and valid option for women who wish to attempt a VBA2C, which I have been saying all along.  But maybe now because a huge medical organization with MD after their names says it, people will understand it truly is a safe choice for mothers to make.

Also included in these guidelines are women pregnant with twins, with a prior cesarean delivery, and an unknown uterine scar, which in the past have meant automatic repeat cesarean deliveries.

Just some numbers to include into this also.

In 1970, the cesarean delivery rate was 5%, in 2007 it increased to over 31% of all deliveries with very little improvement to maternal and neonatal outcomes. VBAC was at about 5% which increased all the way up to 28% in 1996. Then the decline started, in 2006 the VBAC rate dropped down to a little over 8%.  Which is horrible for our women here in the U.S.

While I stand by women being informed on making their own choices regarding their care, as a mother who has had two cesarean deliveries, researched, learned the numbers, the risks, and everything involved in VBAC vs. ERCD (Elective Repeat Cesarean Delivery) the risks for a repeat c-section are much higher than a trial of labor after a previous cesarean. You are more likely to have long term complications, be re-hospitalized, need a type of blood product, and all the risks that go along with major surgery when opting for a cesarean over a trial of labor.

The risk for a uterine rupture is between 0.6-0.8% with one previous cesarean delivery, and the most recent studies and numbers has not shown a neonatal death from uterine rupture. I am not sure the amount of years it has been, but per the information from the NIH VBAC consensus, it has been at least 10 years since they have documented a case.

Maternal mortality rates are higher with elective repeat cesarean deliveries over VBAC also. When comparing ERCD to VBAC, per 100,000 births, there are 9 less maternal deaths with VBAC than elective repeat cesarean delivery. Hence showing that VBAC is safer, despite all the discussion of risks.  Those are 9 mothers, sisters, daughters that can and should be saved!

I think that these new VBAC guidelines are certainly a step in the right direction, while the change may not take place overnight, we are seeing that it is something now being addressed on a large public forum as the backlash of high cesarean rates are starting to take their toll on our women and babies.

March 28th, 2010

Weekly Round Up

I have found that some of my readers really enjoy the weekly round up posts, so I am going to continue them as long as I have things to round up each week! Hahah!

This week there were quite a few things to highlight, but certainly not as much as there has been in the past.
I will start off with highlights from my house this week :

• Everyone got sick. Real highlight huh?  Both boys got croup for the first time.
• Camden went to his first Easter Egg hunt!
• Benjamin is starting to try and pull himself up to stand. (I am done for once that happens)
• I opened my own Online Mark Store!  Come by and see if there is anything you are interested in, their products are awesome!!

On the internet blog circle :

• When Labor & Delivery Staff Behave Badly : I have seen posts about this all over the internet on various blogs, but because I love Gina, and she actually had a picture of the exchange, I decided to feature her post. I love some of the comments on it. Last night my Husband sat down and read it while we were having our Pizza dinner and he stopped eating and told me he was completely disgusted. Not much can make make him stop eating!
• Dou-la-la knocks one out of the park with her Weekly Movie about The Food Revolution that aired on ABC Friday Night. Baby was asleep, DH had the toddler with him at the fire house, and I watched it. I was completely disgusted and astounded that this is such a problem and I really hope this opens the eyes of the American public.  Another great post about Jamie Oliver’s Food Revolution comes from Peaceful Parenting.
• Amnesty International Slam Dunk’s craptastic “Dr” Amy’s post on Maternal Mortality in the United States.  I can say that there are only a hand full of people in life I “hate” because it is such a strong word, but the more I read this bitch write, the more I think she is just an internet troll with no real education.
• Great post in Mothering Magazine which turned out to be a very interesting read : Is Aluminum the New Thimerosal?
• Even though I was taking with local superstar Amy Romano about this a couple weeks ago, I finally had the chance to see it : This 1-Year-Old Happy Meal Has Aged Surprisingly Well.
• The ICAN Blog covers the ACOG Spokesmen talking about the rising cesarean section rates.

I hope you enjoy these highlights as much as I did this past week. If you have any highlights you would like to have included in my weekly round up posts, please e-mail them to me at Danielle.Elwood@gmail.com.
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