On Preventing Caesarean Births

As a practicing obstetrician/gynecologist, I’d like to comment on the article about C-section prevention.

Doing a C-section and getting a “good” baby can always be justified. Not doing one and getting a “bad” (i.e. brain-damaged) baby can never be.

Doing VBACs (vaginal birth after Caesarian) in properly selected cases appears to be quite safe. The literature gives a risk of approximately 1% for serious complications (ruptured uterus, massive hemorrhage, etc.). If I do two VBACs a month for the next four years . . . which of my patients will be the one to have a major complication? Will she say to me, “Well, doc, that’s the breaks,” or will her lawyer say to me, “Due to your negligent treatment of my client, she has sustained serious and permanent injuries. . . .”?

A three-hour second stage of labor without continuous fetal monitoring and significant progress toward labor constitutes, I think, less than optimum obstetrical management.

My adoption file is so full of letters from childless couples, desperately anxious to adopt a baby under any legal circumstances, that I find it hard to understand women who can bear their own children but are disappointed, saddened, depressed, etc. because, “the delivery didn’t go as I had planned it or as I wanted it.” Is Blaise Moriarty any less precious or special to his parents because he wouldn’t fit through his mother’s pelvis?

VBACs are fine if that’s how you want to go, but remember, in the phrase having a baby , it’s the baby that’s far more important than the having.

JOHN ELFMONT MD

Torrance