Patient safety at heart of state senator’s bill
egarding “Bill could increase risk to pregnant women” (Our Views, Jan. 30): It is certainly no surprise that the issue at the heart of Sen. Ervin Yen’s Senate Bill 747 has prompted concern and controversy. Childbirth is one of the most important and emotionally powerful events in the life of any human. There is no doubt Yen is motivated by one issue: patient safety.
Vaginal birth after cesarean delivery (VBAC) has a long and twisted history. The pendulum has swung back and forth during the past century based largely on concerns of safety and more recently medical liability. The good news is that the current stance of the American College of Obstetricians and Gynecologists (ACOG) is fully in support of VBAC and acknowledges that 60 percent to 80 percent of “appropriate candidates” who attempt VBAC will be successful. And while ACOG insists that hospitals and accredited birth centers are the safest settings for birth, they recognize that each woman has the right to make her own decision regarding delivery. Understanding the very personal nature of this issue, ACOG guidelines emphasize the importance of patient autonomy.
While it’s true that a successful VBAC has fewer complications than an elective repeat cesarean, it is equally true that a failed VBAC has even more complications than an elective repeat cesarean. SB 747 isn’t intended to prevent VBAC or home births, nor is it seeking to limit the use of qualified nurse midwives. Uterine rupture is certainly rare, but it is also completely unpredictable and unless qualified staff are “immediately available,” the potential for severe injury or death of both the mother and baby is very real.
SB 747 isn’t intended to prevent VBAC or home births, nor is it seeking to limit the use of qualified nurse midwives.
The editorial’s assertion that there is a paucity of doctors and facilities willing to participate in VBAC is only partially true. Most facilities that cannot provide around-the-clock, immediately available obstetricians and anesthesiologists appropriately avoid planned VBAC deliveries. Most tertiary care centers regularly participate in VBAC, exercising the appropriate level of caution in the name of patient safety.
In its 2016 opinion, ACOG lists previous cesarean as an absolute contraindication to planned home birth. In the catastrophic case of uterine rupture, immediate cesarean is mandatory and the significant delay required to transport would jeopardize the life of mother and baby.
Certified nurse midwives are talented and valuable members of the health care team who practice in patient’s homes as well as rural and metro hospitals. Most counsel their patients against VBAC at home after an appropriate discussion of the known risks and benefits. Lack of appropriate respect for safety is justification for SB 747.
Your contention that a woman has the right to accept the known medical risks certainly has merit, but what about the unborn baby who will likely die in the case of uterine rupture outside a hospital setting? I doubt anyone would suggest ignoring a parent who chose not to secure their infant in a car seat for a drive across town.