Henci Goer's piece, When Research is Flawed: the Safety of Planned Vaginal Birth after Cesarean, uses solid evidence-based research to support vaginal birth after cesarean. The student in me has always believed that good research can bring enlightenment. If they only knew the facts I would sigh, designing some intricate regression to justify the importance of believing in impoverished communities. Yet I suspect that in this case as well, research is not going to change ACOG's position. The reality is that according to Goer's analysis of the research, approximately one in ten thousand babies won't make it when uterine rupture occurs and ACOG, blind in their pursuit of birthing all babies with perfect apgars, is willing to risk the lives of future babies and the health of mom to save the life of one baby now. So ACOG's stance seems to be more about power then good research.
ACOG is not God. All babies were not meant to stay with us in this world. My parent's lost their first-born at age two and the loss has weighed heavily on our family at times. But there is also the thought that without the loss of the first child, the third child might never have been born (my parents planned on having two children), and who could imagine life without my amazing and dearly loved little sis. Somewhere within sorrow there is always birth. It may be the birth of a new child (I was conceived about a week after the loss of my sister, but that is another story) or it may be the birth of a new found strength as you weather a loss that at times threatens to tear your heart apart.
For those of you wondering why I am flinging my frustrations at ACOG, it is thanks to ACOG that we have many hospitals who will not perform VBAC. According to the ACOG practice bulletin1 "“VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available.” The problem lies within the phrase "immediately available." Small hospitals don't have the resources to keep surgical teams standing around on the maternity floor waiting for the very unlikely event of uterine rupture. And according to Dr. Marsden Wagner, there is ZERO data to support ACOG's position.
Since there is no data, all I can assume is that ACOG insists on being the valiant knight, blindly brandishing its sword to save the frail princess locked in the tower (babies, like women, are often much stronger then our culture will acknowledge). Whether you are VBACing, a first time mom, or a mom of four, birth can end in death and not even ACOG can save us from that reality. The good news, is that most pregnancies in the US end in healthy beautiful babies. If you are pregnant, repeat after me, I will have a beautiful and normal birth.
1 ACOG Practice Bulletin. Vaginal birth after previous cesarean delivery. Number 5, July 1999 (replaces practice bulletin number 2, October 1998). Clinical management guidelines for obstetrician-gynecologists. American College of Obstetricians and Gynecologists.