15 March 2009

Turn the Tide of Cesareans

I was pleased to learn about a presentation at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting in January, 2009, about a study (albeit small) that showed that by using a sonogram to measure the lower uterine segment (LUS) thickness of the uterus, doctors could successfully predict uterine scar defects in women who had previous cesarean deliveries. This would allow them to determine which patients are at risk for subsequent uterine rupture if they attempt vaginal birth after c-section (VBAC).

Such a method could go a long way in preventing cesareans, and also could give some ammunition to women who are now being denied VBACs throughout the US under the guise of “risk,” often uterine rupture. Perhaps this is the first step we need to turn the tide, giving the evidence needed for malpractice lawsuits against doctors who are more concerned about their own schedules and pocketbooks than the well-being of women and babies.

To read an article about this study, go to Reuters Health Information

Cheryl K. Smith, Midwifery Today Managing Editor

Also read these articles from the Midwifery Today site:

The VBAC and Cesarean Prevention Handbook has many articles by midwives, doulas and mothers on the powerful experience of VBAC.

Comments

# Joy Johnston said:

Hi Jan.  I'm afraid I did not share your optimism when I read that piece.  

I wonder why the rate of scar dehiscence and rupture is so high in the study group.   What were they doing to those women?  Is this the usual rate when the uterus has been closed in a single layer?  

Surely the logical conclusion is that a better surgical technique needs to be developed to reduce risk of scar problems.

How many women are going to be prevented from labouring as a result of this measurement?  

I can see women being told they cannot attempt vbac when, in the care of a competent midwife the woman could reach an informed decision, including whether or not they accept the 'help' that comes from modern toys.

Monday, March 16, 2009 11:54 PM
# scientistmom said:

I hope they are getting a good baseline of how thick (or thin) a women's uterus gets that hasn't had a c-section.  Doctors like to say things like 'your uterus was so thin, you're lucky we did a c-section'.  But the truth is they don't know what the 'normal' measurement is.  And even if they can measure it, they don't know at what thinness there may be a problem, or even if the actual measurement is the best indicator of a potential problem.  None of this has been properly researched.  

The risk of uterine rupture after a modern c-section is fairly low.  And in general the risks of a repeated c-section out-weigh the risks of uterine rupture.  Women need to be told the risk of both and then allowed to decide what they believe is best for them and their baby.  I am not convinced of the predictive ability of this measurement.  

Monday, March 23, 2009 8:50 AM