WOMENS-HEALTH Messages for July, 2000: Re: VBAC at home???

Re: VBAC at home???

From: anonymous@obgyn.net
Wed, 5 Jul 2000 16:06:47 -0500 (CDT)

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At Wed, 5 Jul 2000, AMD wrote: >
>I have a friend who is 6 months pregnant with her 2nd child. The first
>was c/s after several hours in labor, but she doesn't know why. While
>participating in LLL, she seemed to get in with some of the
>"anti-doctor" types who convinced her that her c/s was totally
>unnecessary -- that if the doctor had been patient enough she would have
>delivered "naturally". So for this baby, these friends have hooked her
>up with a midwife who will deliver her baby at home. I personally think
>this is a BAD idea and have told her so. I know several people who have
>delivered at home and have totally loved the experience, but a VBAC at
>home seems unnecessarily dangerous. It may be fine, but the bad can be
>catastrophic. I have also heard several stories from my mom (a NICU
>nurse) about babies who were lucky(?) enough to survive a home birth
>gone bad.
>
>I am also concerned because I can't get a fix on this midwife's
>qualifications -- my friend doesn't know if she's a CNM or lay midwife,
>whether she has any hospital privileges or OB backup. The midwife is so
>positive with her, that my friend doesn't think it will matter -- the
>baby will pop out at home with the help of the midwife and everyone will
>be happy. I'm worried that the midwife hasn't really spelled out the
>risks involved or how likely she will be to need another c/s.
>
>So am I just being paranoid about this? Do midwives routinely do VBAC's
>at home? Is there a good reference to provide my friend to help her make
>an informed choice? And is there any way to check out this midwife? I
>know I would be much more comfortable if she would at least go to a
>birthing center.
>
>Thanks,
>Andrea

Home VBACs are a very poor idea, especially in this circumstance, when neither the patient, nor her "caregiver", appear to have the slightest clue as to why the C/S was performed in the first place. Do they even know, or for that matter even care, if the uterine incision was transverse or not? Her risk of rupture could be anywhere from < 1% all the way up to >15%, and they don't even know one way or the other. If the uterus does rupture, the mortality for the baby is about 50%, and morbidity approaches 100%, and that is in the hospital.

This is an amazing thing to me. It is the people who evidence the most concern about their pregnancies that are most likely to follow this dangerous path, blithely ignoring the hazards of the course. Sometimes it seems as if we have entered the Dark Ages all over again. Virtually anyone can declare themselves a mid-wife, and start a practice delivering at home. People use more caution selecting the hamburger they are going to cook for dinner than the amateur they have chosen to handle their pregnancy.

I have the utmost respect for Certified Nurse Midwives, a group who have the education and experience to handle most births, though I would have to strongly, if respectfully, disagree with those few who do home VBACs. As for those with little to no training, the lay widwives, why not just do it yourself?

My father was an airline pilot for 35 years, and a Navy fighter pilot for 5 years before that. I have 100 hours in a single engine Cessna. Which one of us would you want to pilot the airplane that carries your children? And do you want them in an aircraft that I built myself, or one that Boeing helped with?

--
William D. McIntosh, MD, FACOG
Clarksville, TN

This is for educational purposes only, and is not intended to be replacement
or substitute for consultation and examination by an appropriate medical
professional.  Due to time constraints, private e-mails cannot be answered.

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