Tuesday, November 30, 2004

Grand Rounds

This week's Grand Rounds is up. Make sure to read this interesting commentary on Vaginal Birth After C/S (VBAC) from a surgeon:

Why shouldn't the choice of the physician or hospital carry some weight? There is always a risk/benefit calculus with such things. The physicians have found that the risk of VBAC (uterine rupture and the complications thereof) outweigh the benefit (patient satisfaction with natural childbirth). The VBAC advocates believe the benefits of a trial of labor and the "birth experience" outweigh the risks of VBAC. So much so that some, like Ms. Stratton, are willing to undergo delivery out of the hospital. Yet the choice of the provider is given short shrift.

And, for women considering a trial of labor after having had a C/S, here's the conclusion of a study that looked at out-of-hospital delivery:

"[A] cesarean-scarred uterus was associated with increases in complications that require hospital management. Therefore, birth centers should refer women who have undergone previous cesarean deliveries to hospitals for delivery."

Update: I forgot to link to this review of some of the risk factors for uterine rupture. Although a bit technical at times, please try to read it. It will give you a better understanding of what an informed consent entails.


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