Letter From OB Explaining VBAC Ban
By Danell Swim
March 26, 2008
March 10, 2008Dear Ms. B,
I was asked to respond to your letter inquiring about Hospital’s VBAC policy. Your letter is well written and asks some valid questions. I will do my best to answer your questions by giving you a historical perspective as well as direct answers.
[….]
Although my primary role involves patient care and administrative duties, I continue to lecture across the country on a variety of obstetrical subjects, with the “Risks and Benefits of Cesarean Section” and “Risks of VBAC” being the two most requested talks I give. I have personally delivered, or supervised the delivery of over 15,000 births, and continue to be involved in over 5,000 patient encounters per year.
[Hospital] is ready to perform emergency cesareans 24×7. In fact, we are remarkably good at it, and can boast about some of the best outcomes in the world. Not meeting some of the recommended requirements for VBAC does not infer a lower standard. Even though we do not have ‘in-house’ anesthesia 24 hours per day, our surgical response time in many cases is better than larger institutions with “in-house” staff. A large University setting may have in-house staff but simply walking from one side of campus to the other may take more time than driving in from home in our small community. Moreover, the volume at some of these large centers and logistic delays often encumber those institutions and negatively impact on their response time, whereas [Hospital] has the ability to mobilize and act quickly when needed.
Nevertheless, being good at handling emergencies is not justification for inviting them. There will always be emergencies in medicine that cannot be staffed or prepared for. It is a sad fact of life that some women in labor will have heart attacks, and some will have brain tumors or brain aneurysms, and some will have emboli, but no system can have a Cardiologist, a Neurosurgeon, and a pulmonologist available on site 24 x 7 waiting for these things to occur.
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