Sunday, August 12, 2007

Uterine rupture

Homebirth and natural childbirth advocates appear to think that the most devastating indictment of modern obstetrics is Cytotec. Cytotec (misoprostol) is a medication used for induction of labor. It was tested extensively before being used in pregnant women, and found to be safe. However, after it was in widespread use, it was noted that in a subset of women (women who had a previous C-section), it increased the risk of uterine rupture. Uterine rupture is a devastating complication that can lead to the death of the baby, to possibly hysterectomy, and even to the death of the mother. Not surprisingly, Cytotec is no longer recommended for use in inducing labor in women who have had a previous C-section.

Cytotec is hardly the most common cause of uterine rupture, and since uterine rupture is such a devastating complication, you would think that any measures that reduce the incidence of uterine rupture would be welcomed by homebirth and natural childbirth advocates. You'd be wrong. That's because the most common cause of uterine rupture is labor itself. Women who have had a previous C-section are at increased risk of uterine rupture if they attempt a VBAC instead of having a repeat C-section. This is the reason why ACOG has recommended that VBACs should not be done unless an obstetrician is present and 24 hours anesthesia and C-section capabilities are available. Since many small hospitals cannot meet those conditions, VBAC rates have dropped precipitously, to be replace by a skyrocketing rate of scheduled repeat C-sections.

Yet homebirth and natural childbirth advocates are horrified by the decline of VBACs and believe that it is thoroughly unjustified. So here's my question:

Why is Cytotec an abomination because it increases the risk of uterine rupture, but VBAC is desirable despite the fact that it increases the risk of uterine rupture?


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