Patients’ safety comes first
April 11, 2002
As pediatric professionals in the Roaring Fork Valley, we feel compelled to respond to the recent controversy regarding vaginal births after caesarean sections (VBACs) at Aspen Valley Hospital.
We agree with Dr. Harling’s statement in his April 9 letter to the editor that “safety implications for the baby” are of concern to us. The well-being of every mother and child delivered at our facility has always been of utmost importance to our practice.
The American College of Obstetrics and Gynecology (ACOG) published guidelines for VBACs which raised levels of concern “because uterine ruptures may be catastrophic.” Uterine ruptures occur approximately in one out of every 100 VBACs, and result in 10 to 25 percent of these babies either dying or suffering severe and permanent brain damage.
A VBAC is an elective obstetrical procedure and its risks should be viewed in that light. These risks can be minimized by performing these deliveries at a medical center specializing in high-risk obstetrics.
These centers have perinatologists, neonatologists, neonatal intensive care units with neonatal nurses, high-risk obstetrical nurses, immediate operative ability and extensive blood supplies in the event of hemorrhage. These services are provided at the larger facilities on a daily basis.
The Medical Executive Committee (MEC) and the AVH Board of Directors reviewed the available medical literature and solicited input from members of the medical and nursing staffs, as well as the public, before reaching a decision to ban VBACs at AVH at this time. Other rural western Colorado hospitals have come to the same conclusion.
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In response to the women who have shared their issues at the public meeting, we are sympathetic to their concerns, but as professional child advocates, do not feel we should bend to pressure that forces us to participate in an elective procedure not appropriate for our facility.
We encourage anyone considering an elective VBAC to travel closer to a high-risk facility before their due date. In all likelihood, they will be in the 65 percent of women who have a successful VBAC, but if there is a complication, it will be handled with the best physical resources and the highest level of specialist expertise.
Aspen Valley Pediatrics has always been and will continue to be available to provide high quality care to all newborn and sick children both in our offices and at AVH. We will continue to stay abreast of the scientific literature on VBACs and will reevaluate our decision as new information becomes available.
In the meantime, our group stands by the decision of the MEC and AVH Board of Directors to put the safety of our patients first and cannot, in good conscience, support an elective high-risk procedure in our rural facility.
William Mitchell, MD
Harvey Fahy, MD
Claudia Nelson, MD
Maddie Simonet, MD
Liz Gremillon, MD