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Wednesday
Dec232009

Do You Suffer from Physician VBAC Hysteria?

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Dr. Chukwuma Onyeije, who bills himself on Twitter as an information-age Maternal-Fetal Medicine Specialist, wrote a blog post about avoiding an unnecessary cesarean following a Twitter discussion that began with this commentary of CNN’s coverage of Joy Szabo’s recent birth:

 

 

In his post, 10 Ways to Avoid an Unnecessary Cesarean, Dr. Onyeije coins the term Physician VBAC Hysteria:

Patient’s trust physicians to make tough calls by virtue of our expertise, training and because they believe that we want what is best for them. My fear is that physicians risk losing the trust and goodwill we have with patients if we steer them away from safe vaginal deliveries toward unnecessary cesarean deliveries for questionable reasons. The current trend towards not offering VBAC may have begun due to concerns regarding safety or even medico-legal exposure; however at present, it has metastasized to inordinate levels that I have referred to as PVH (physician-VBAC-hysteria).

In the comments, he outlined his opinion of the VBAC-hostile policies in the United States: 

The underlying problem in the VBAC dilemma in the United States is related to the fact that more than ever before, OB/GYNs are incentivized to provide intensified care to low-risk women to justify their services. Along with the numerous reasons for increasing CS rate in the US is the problem that far too many low risk pregnancies fall into the net of overtreatment and unnecessary intervention that is modern obstetrics. It is a difficult idea for most OBGYNs (and maternal-fetal medicine specialists like my self) to accept for a few reasons. At the risk of sounding like a granola crunching Birkenstocks wearing MFM I’ll suggest two problems.

First, we all wish to believe that we are making decisions based on what we feel is the best evidence. If confronted with evidence that we may be upgrading risk in low risk women to cushion the bottom line, many would object strenuously to the charge. As I’ve indicated above, I don’t think this is the result of avarice or dishonesty. Rather, I think it is related to incentives which encourage such behavior to sustain financial relevance.

Second, the process whereby the definition of “high-risk” has shifted downward has occurred slowly and no doubt imperceptibly to many physicians. I would venture to say that most doctors trained within the last 10 years (and in particular areas of the country) feel reluctant to provide VBACs as much due to medico-legal fear as a constitutional distrust for the procedure based on limited experience. The same could be said for vaginal breech deliveries and forceps deliveries.

So the problems that we face in moving back from the brink of what threatens to be CS rates in the 40% range nationwide is daunting.

I am hopeful that the seeds of a trend toward physicians acting as trusted consultants for patient’s best interests are being planted by patients themselves. New technology and the democratization of information makes it much more reasonable for patients to participate in their care.

 

Related Posts:

CNN’s Elizabeth Cohen on How to Fight for Vaginal Birth

Defensive Medicine and Internet Message Boards

VIDEO: CNN’s Elizabeth Cohen Discusses VBAC and Cesarean Section

Joy Szabo Interviewed by Ron Reagan on Air America

Joy Szabo Made Some Noise about a VBAC Ban, CNN Listened

Your Right to Refuse a Cesarean: ICAN’s Guide to VBAC Bans

ACOG Releases Survey Results: OB-GYNs “Ultimately Hurt Patients”

 

 

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Reader Comments (9)

Good stuff!

December 23, 2009 | Unregistered CommenterDiana J.

Hear hear! It warms the cockles of my heart to see a doctor with his head on straight! He nailed the reasoning behind the lashing out that so many docs do when confronted about their non-evidence-based practices: because they know they are becoming obsolete, and don't want to let it show.

December 23, 2009 | Unregistered CommenterJill

Along with Academic Ob/Gyn, Dr. Onyeije is my new favorite tweeter and blogger! I am soooo reassured to read the thoughtful posts they have been writing. I am thrilled to hear an MFM specialist talking about democratization of information and participatory care. I hate to say I was getting discouraged about finding good role models in my chosen profession. I have met good practitioners, many of them, don't get me wrong, but these two are real gems.

December 23, 2009 | Unregistered CommenterMomTFH

very encouraging! Take the victories when they come!

December 23, 2009 | Unregistered CommenterKelly

It's sad that doctors would feel so incapable of attending what is, really, just a vaginal birth, with heightened awareness/monitoring of symptoms for a specific risk. It's always strange to me when people talk about "performing" VBACs, or whether hospitals are able to adequately "do VBACs" as if you need some kind of special tools. Those people should talk about whether hospitals are able to adequately "monitor for complications" and "do emergency c-sections" and if not, then what's up with all the hospital birth hype? /preachingtothechoir

December 23, 2009 | Unregistered CommenterRebecca

Oh no! Not another "natural" birth advocate! LOL

December 23, 2009 | Unregistered CommenterAnon

I wonder if your stalker---er, lover---is on Christmas vacation. Hmmm...

December 26, 2009 | Unregistered CommenterMonkey Mama

She's moved on to the My Best Birth site - for the moment.

December 27, 2009 | Unregistered CommenterDou-la-la

I want to trust these types of docs - the ones that go on Twitter and blogs touting less invasive/more natural birthing methods. It seems though, that just when I start to think they might be on my side, one posts a blog essentially saying he'd sign his wife up for 5 cesareans before he'd ever support her decision to homebirth (ala the comments made by Academic OB on his recent VBAC post.) Can't trust anybody who'd choose an unnecessary surgical scar 5 times over a planned home birth. Nope. Can't do it. And I fear they are all the same. Hysteria? Yep, I've got it. Hysterically avoiding anyone with a medical degree, which seems to make them all soul-less bullies with no sense of common decency.

But I'll be keeping my eye on Dr. Chukwuma Onyeije. If only more doctors sounded like he does.

December 27, 2009 | Unregistered CommenterThe Feminist Breeder
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