Debate Over Vaginal Birth After C-Section

I read “Once a C-Section Always a C-Section? Yes, Insist Many Experts” (Feb. 5) with great interest, because my first child (a 6-pound, 10-ounce breech baby) was born by caesarean section, and the last two (both 8 pounds, 5 ounces) were born vaginally. My C-section was extremely painful because I wasn’t given enough anesthesia, and I could feel every stitch as I was sewn up. I never wanted to go through that much pain ever again.

My obstetrician was neutral when I expressed I wanted to try a VBAC. Even though I’m one of the older mothers who are often talked about in articles, my second birth was relatively easy. I went to the hospital at 3, started pushing at 4 and had a baby by 4:30. With my third, I was at the hospital at 7 and he was born at 7:40. As I listen to the other moms who plan their second and third C-sections, I’m most struck by the fact that moms tend to go along with whatever the doctors suggest. Had I not been so adamant about a VBAC because of my C-section experience, I suspect my other children would have been born by caesarean too. In retrospect, it seems to me that if childbearing pain were more than a woman could handle, evolution would have provided us with another way of producing offspring.

--SUE LARSON PASCOE

Pacific Palisades

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The article “Once a C-Section . . .” presents the dilemma faced by many women and their obstetricians. However, to state that the strict rules of many hospitals “may be endangering lives” is hardly fair.

If a uterine scar ruptures, the mother and baby are in immediate danger of their lives and the obstetrician is in danger of a lawsuit. Immediate life-saving intervention is not generally available in many smaller hospitals. Under such circumstances, a C-section has the advantage of maximal safety over the 1% to 2% risk of a serious complication of VBAC. From the standpoint of safety, a home delivery is the worst possible solution. When a hospital cannot guarantee the immediate availability of an obstetrician and anesthesiologist, the patient should be referred to a center with more facilities. With lawsuits being part of the American culture, it may not surprise one that many obstetricians in this country choose to adhere to the safest solution--as recommended by the American College (not Academy) of Obstetricians and Gynecologists--even if that is in contrast to their patient’s wishes.

It is a Faustian bargain. How many more brain-damaged infants will it take before we accept that VBAC outside a major medical center is not in the best interest of either mother or infant?

--DR. LAWRENCE D. LONGO

Center for Perinatal Biology

Loma Linda University

School of Medicine

Loma Linda