I agree with you that in an ideal world where women received optimal care (defined as care that uses the least intervention to achieve the best outcomes given the woman's individual circumstances), a hospital VBAC would be preferable. Unfortunately, we do not live in such a world--at least not in this country. In many cases, women cannot get a VBAC at all, which amounts to forcing them to agree to major surgery in order to obtain medical care, or they can only get what I call the "Cinderella VBAC" except without a fairy godmother to magically overcome the stepmother's obstacles: "You can have a VBAC IF you only have one prior cesarean and IF your prior cesarean wasn't for dystocia and IF the baby isn't too big and IF you go into labor by your due date and IF you progress smoothly and quickly," and, in Jeannie's case, "IF you get pregnant at a sufficient interval from the last pregnancy." You might respond that Jeannie didn't say she was denied a VBAC, only that she was "recommended" a cesarean, but you can imagine the difficulties for a woman in labor to be attended by medical staff who disapprove of what she is doing and think it is risky.
I think, too, that if you will reread my response, you will see that I did not try to talk Jeannie into (or out of) a home birth. I did for her what she was very unlikely to get from her care providers: I gave her the objective facts, to wit, that the odds were 99% that she would not experience a scar rupture and possibly better because she would not be exposed to interventions that would increase her risk. I give Jeannie credit for understanding that 1% isn't 0% and what the possible consequences of scar rupture might be. I take my stand on the principle that women have the right to informed consent and refusal. What women almost always get from medical care providers, though, is an attempt to persuade them to do what their care provider thinks they should do. (There is data on this point, for ex., Listening to Mothers II, a survey of U.S. women giving birth in 2005, found that most women, including women who had cesareans, either did not know or got wrong four questions on cesarean complications.) I hope you will forgive me for pointing this out, but your own response of telling a story of a home VBAC gone horribly wrong falls in that category. If I had wanted to push Jeannie toward home birth, I could have told an equally terrifying story of a catastrophic outcome of an elective repeat cesarean or cited the frightening statistics on the increasing risks with accumulating cesarean scars.
As for how things went for Jeannie, we can't know that unless she chooses to post again. And in answer to your other question, some of my posters are midwives or nurses, obstetricians: not so much.
-- Henci |