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| 11/12/2005 2:01 PM |
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If a baby dies in a vbac birth, not related to a uterine rupture, does that count as infant mortality due to vbac? For example, a baby dies in a vbac to shoulder dystocia--- to me that should not be attributed to the vbac, but as a regular birth problem. I am wondering what my "true risk" is from a vbac birth. There are risks in every birth, but how much does my risk go up in a vbac.
Thank you so much Henci for your commitment to birth and helping families. By: MommyDOK |
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Archived User
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| 11/14/2005 12:36 AM |
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Population studies of VBAC births do, indeed, include intrapartum (during labor) and neonatal deaths (deaths in the 1st week after birth) from all causes, not just those associated with scar rupture. A good example is the study of VBAC at birth centers, Lieberman et al. 2004. This was a study of 1453 women with prior cesareans who were eligible for birth center care at the onset of labor. Seven babies died for a mortality rate of 7/1453 = 4.8 per 1000. Of these deaths, only 2 were related to scar rupture. (There were, by the way, six cases of scar rupture, one of which was not diagnosed until after the birth and another--not one in which the baby died--was diagnosed when the woman arrived at the birth center.) The case history of the other five deaths were as follows:
"fetal bradycardia [slow heart rate] on arrival at birth center; true knot in cord"
"failure to progress; fetal bradycardia developed during transfer"
"blood tinged amniotic fluid; likely marginal [placental] abruption" This woman was at the birth center less than 20 min before transfer. It is worth noting that prior c/sec increases the risk of abruption.
"status post shoulder dystocia"
"breech; prolapsed cord on arrival at birth center"
The mortality rate related to scar rupture is 2/1453 or 1.4 per 1000, and the non-scar related rate is 5/1453 or 3.4/1000. One could speculate on which, if any of these deaths, might have been avoided had the woman arrived in labor at a hospital instead of a birth center.
Also, as I noted, the death attributed to a probable placental abruption was from a cause associated with prior c/sec. This death, together with those following scar rupture, is a cautionary tale on why the use of c/sec should be minimized. If the first c/sec could have been avoided in these three cases, it is likely that those babies would be alive and well today.
-- Henci By: Henci Goer |
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