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Re: Alana's Surprise stillbirthFrom: Deborah Wage, FNP,CNM (wagedj@bellsouth.net)Sat Oct 28 09:09:26 2000
> There is nothing unreasonable about a second stage of 3 1/2 hours. Most reasonable practitioners realize that second stage length is highly variable and as long as progress of some sort is being made and there is reassuring fetal and maternal status we carry on. HOWEVER, a VBAC is not a 'normal' nor low risk labor.....prolonged second stage can indeed be a huge red flag in a VBAC and even more so depending on the reason for the c-section. I cannot agree with your statement about this Alana
> I, myself, am a well informed low risk woman who had a home VBAC I have to respectfully say that I disagree. A VBAC is not low risk.
and I
> don't really believe being a VBAC alone should risk you out of homebirth This is a trigger point for me. Remember, I had 3 home births and believe it to be a safe alternative with the right attendants, back up arrangements etc. But I cannot accept the known, albeit it low, catastrophic risk of uterine rupture being an acceptable one in the choice of homebirth. Even the most SKILLED OBSTETRICIAN cannot 'fix' this one in the out of hospital setting. The argument of someone having a 100% success rate (i.e. svd's and no ruptures) as evidence of it's safety is just so flawed. It is a numbers game Alana. If you do enough VBACs you will have a rupture. It isn't like intact perineums where some skill is involved in accomplishing this. If you have 85 scarred uterus's (plural?) that undergo labor and don't rupture then BFD............number 86 just might. And the 'risk weight' is much more than the likelihood of it happening...........it also has to do with WHAT ARE THE CONSEQUENCES if it does. One must make decisions based on a more sophisticated understanding of risk/benefit/chance/life/death. I feel that is missing in your understanding in the nature of this particular risk.
-- Deborah Wage, MSN, FNP,CNM
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