As a still-practicing obstetrician of over 30 years, I extend kudos to your freelance writer Taffy Brodesser-Akner for her wonderful first-person piece "The Birth of a Dilemma" [April 26]. She did a great job of presenting VBAC (vaginal birth after C-section) from both a practical and emotional standpoint.
Unfortunately, with no tort reform coming soon, many hospitals are reluctant to allow VBACs to even occur within their delivery suites. Money talks!
Michael L. Friedman, MD., FACOG
Surely, attempting a vaginal birth after cesarean comes with its risks, but so does vaginal birth with no prior history of cesarean.
The chance of uterine rupture exists whether or not a woman has previously had a C-section. True, women who attempt a VBAC are at a slightly higher risk of uterine rupture, but this risk is too small to subject all women who have had a previous cesarean to a repeat cesarean.
In fact, research suggests that without a compelling need for a C-section, a vaginal birth is actually safer overall than a repeat C-section.
Women who are medically fit to attempt a VBAC should be encouraged and supported to do so. The real issue is that doctors either frequently pressure women into the repeated cesarean by convincing them that a VBAC could threaten the lives of themselves and their babies or leave the decision entirely up to the mom without pointing them to any sources of quality information to help them decide.
What is truly needed is a mandated class for VBAC candidates that would allow them to become more knowledgeable about the true risks and benefits of a VBAC or repeat cesarean.
Despite the fearful tone of Brodesser-Akner's article, we believe that VBAC is still a good choice for many women. Obstetrical risks for low-to-moderate-risk women in childbirth are frequently overstated, leading to a pervasive fear in the U.S. of normal birth.
In our practice of obstetricians and nurse-midwives, 80% of low-risk pregnant women who desire trial of labor after one C-section deliver vaginally. Though the risks of VBAC were highlighted in the article, the benefits of vaginal birth compared to a planned cesarean section were not. Faster time to heal, shorter hospital stay, reduced risk of infection or hemorrhage, less risk of breathing problems in the infant and a quicker return to normal activities are just a few of the benefits.
Future childbearing should also be considered because maternal risks, particularly of hemorrhage resulting from placental attachment to the uterine scar, increase with subsequent operations.
The ultimate goal for everyone is a healthy baby and mother, regardless of the mode of delivery. Choosing to undergo VBAC should involve a clear understanding of the risks and benefits as discussed in the medical literature.
Betsy Jenkins,CNM, MPH and Laila Al-Marayati, MD
Eisner Pediatric and Family Medical Center, Los Angeles
Your April 26 article on "best hospitals" ["Hospital Rankings: Are They Reliable?"] was very interesting. But it didn't point out the importance of intangibles.
For instance, comparing death rates often is of lesser value because the best hospitals get the most serious cases, which naturally have higher death rates.
Other than omega-3s
Thank you for the extensive April 26 article on omega-3s ["Omega-3s: Not All Alike"]. Omega-3s can be really helpful in lowering a person's total cholesterol as well as boosting the "happy" HDL number — or not. In fact, many people who "do all the right things" to lower their cholesterol — taking fish oil supplements, having a glass of wine with dinner — may actually increase their total cholesterol as well as both the "happy" HDL and the "loser" LDL.
I cannot take statin drugs because of another condition, so I must manage my elevated cholesterol through diet and other supplements. I was surprised to learn through more comprehensive cholesterol screening that my genotype is one for which fish oil can increase both my HDL and total cholesterol significantly — which would explain why my numbers went up 20 points the first year while I was on the prescription-strength fish oil, Omacor.
I switched to a good over-the-counter flax seed oil and my total cholesterol went down by 40 points over the next year.
People who would like to avoid taking pharmaceuticals or who have not lowered their cholesterol enough through diet and exercise along with statins would do well to seek out such screening. I went to a holistic endocrinologist, and it was well worth the out-of-pocket expense to see a specialist outside of my HMO.
Rancho Palos Verdes
The yoga connection
All week long, my students mentioned the article in the L.A. Times about yoga ["Yoga Don'ts — and Do's], April 19]. My students wanted my input and suggested I send it to the L.A. Times.
The article does not carry the essential element of union, which is at the very heart of the meaning of the word "yoga." Yoga is about the union of physical and spiritual, body and mind, form and formlessness.
This article is based on a philosophy of separation. It only talks about form and further exacerbates the issue with an either-or approach of don'ts and do's.
"Yoga is really about getting to know your body" is a statement that sadly reflects how far we in the yoga community have fallen. Yoga is really about integrating your body, breath and mind to connect to your spirit.
This article on a subtle level runs the risk of distorting the meaning of yoga by painting a detached physical form in a world of black and white. How you practice yoga is important. If how you are going to practice yoga separates your breath, heart, mind, soul and spirit from your physical form, and then call postures just good or bad, it does not help us to grow in wisdom or spiritually.
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