July 22nd, 2010
11:16 AM ET

Vaginal births after C-section usually OK, docs say

Delivering a baby vaginally after a C-section is a “safe and appropriate choice” for most women, the American College of Obstetricians and Gynecologists said Wednesday.

The practice has been discouraged by many doctors and insurers in recent years.

Under the new guidelines, women who have had two previous C-sections or are carrying twins are among those now considered appropriate candidates for a vaginal birth after Caesarean, or VBAC.   Between 60 and 80 percent of women who attempt VBAC will be sucessful, the doctors said.

The guidelines "emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy," says Dr. Richard N. Waldman, ACOG's president, in a press release.  "The current C-section rate is undeniably high and absolutely concerns us ob-gyns."

The recommendations come after years of many American hospitals and doctors insisting women who have C-sections continue to do so with subsequent births.  The rate of Caesareans has increased from 5 percent in 1970 to over 31 percent in 2007.  Waldman blames the "onerous medical liability climate" for the dramatic increase in C-sesctions.   "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."

Not every woman is a candidate for a VBAC.  Women who have to have an emergency C-section after attempting a VBAC may have a higher risk of injury. At the same time, a successful VBAC has fewer complications than a repeat Caesarean.  Click here for some of the pros and cons.  Experts say if you are thinking about having a VBAC, it is important to talk with your ob/gyn early in your pregnancy.

The conflict over the policy was captured on CNN in the story of Arizona resident Joy Szabo, who wanted to deliver her fourth child by VBAC. Because the hospital in her hometown, Page, Arizona, did not allow vaginal birth after Caesarean, Szabo had to leave  her family in the last weeks of her pregnancy and move to Phoenix to be near a facility that would allow her the childbirth she wanted.  (She delivered vaginally with no complications last December.)

soundoff (169 Responses)
  1. Middle Ground Anyone?

    Medical care (ob care and med care in general) should be decided on an case-by-case basis. The medical care team, patient and patient's family should come up with a plan together.

    Why do these guidelines really exist? Are they about patient safety? NO!!!!! They are designed to let insurance companies decide which plans of care they will pay for and to allow hospitals to dictate policies to patients and physicians. Every few years, they decide what was bad before, is wonderful now because they have "evidence." Remember hormone replacement, eggs, daily aspirin? They were good, then they were bad, then it was good in some cases only....the cycle continues.

    Our health care should not be reduced to cookbook medicine, with the same recipe for every patient. Also, the legal environment has to be stopped as there are too many frivolous lawsuits, especially in OB. I have heard that some people sue not because they really feel the doctor is at fault, but because they need the money to take care of a permanently handicapped child. How else do people go from trusting someone with their life and the lives of their loved ones to "suing the pants off 'em?" If a patient signs a consent form and agrees to a plan of treatment, then suing should be off the table. If the patient truly feels wronged, they should be entitled to go after the doctor's license to make sure that doctor doesn't practice again. Money/lawsuits should be out of the equation.

    July 24, 2010 at 12:16 | Report abuse | Reply
  2. Kimberly

    I am a woman and I'd like to make a suggestion to other women: YOU are the ones who have the babies so do exactly as YOU want to do!! I do not care what doctors have to say in the least, I do exactly as I please regarding my body and that is as it should be. My experience has been that the vast majority of doctors are completely profit motivated and do not know what the hell they are talking about. In fact, their incompetancy is often only eclipsed by their arrogance.

    July 24, 2010 at 12:27 | Report abuse | Reply
  3. JustSaying

    This country has become littered with ambulance chasing lawyers and trash willing to join their bandwagon in suing at the drop of a hat. Yes, malpractice and flagrant errors occur where reparations are certainly due – but so many are not the case. Doctors are being ran out of the business of delivering babies and tending pregnant women because of not being able to afford the malpractice insurance. If a patient chooses to assume the risk – fine ... but way too many juries have still sided on the side of the patient even when the patient knew the risks and made the choice against professional advice.

    July 24, 2010 at 12:30 | Report abuse | Reply
  4. Jeff

    Don't be stretching all those vaginas out..........

    July 24, 2010 at 13:22 | Report abuse | Reply
  5. Jerry

    Its all about the liability $$$$

    July 24, 2010 at 15:31 | Report abuse | Reply
  6. K

    I had a perfect pregnancy...flawless...I'm super healthy and so was our son...up to 5 days before I was due. We had less movement one morning and rushed to the Hospital and was checked in. We would deliver our son that day. His heart was strong but dropped in rate when I would contract...from that our wonderful Doctor knew our son wouldn't handle a vaginal birth so we started the prep for a C-sect. Before I had an epidural our son started to crash and I was rushed to the OR for an emergency C-sect. He suffered a very rare massive fetal maternal hemorrhage in the placenta so all his blood drained into me before they could get him out. When they did, they did a transfusion & CPR for 12 min. & he came back. He died in my arms the following morning due to the complications. He was and still is our only child.
    We planned a home birth with a very experienced Midwife and also went to regular visits to our OBGYN. We had set things up with the hospital in case we needed to go there just in case. I can say now...only because of my experience...thank God for Hospitals and good doctors. In my case, I will never risk having a VBAC and risking another hemorrhage. It does happen, I'm living proof and I was a low risk. Whatever the percentage is, it's too high for me. I couldn't make it through this pain again.

    July 24, 2010 at 19:56 | Report abuse | Reply
    • Ituri

      All my thoughts for your loss... but it is still each womans choice, how to give birth, despite the risks. The choice should not be taken away from them by hospitals that deem it a "legal liability."

      July 25, 2010 at 11:47 | Report abuse |
  7. teresa, ohio

    @K: I'm sorry for your loss and unfortunate experience.

    July 24, 2010 at 21:25 | Report abuse | Reply
  8. kim

    My 1st child was born by C-section because she was breech. My 2nd child was born by VBAC everything seemed to be good up until a few months later when I started having pain. However, I didn't do anything about the pain until it was so bad I couldn't stand it any more. My husband and I found out that my insides were literally torn up from the VBAC. I have had at least 6 surgeries up to date and am having more surgery in August 2010 to repair all the damage done to my body due to the VBAC. I would never recommend a VBAC to any woman. I feel lucky to be alive from my VBAC.

    July 24, 2010 at 22:08 | Report abuse | Reply
  9. Angela

    I have two kids, one by a section and the second a VBAC. There is so much attention given to the "birth experience" when in fact it is just the way to get the kid out into the world. Now that I have the children it's not a big deal how they came out, just that they came out healthy. Pick the method that is safest and remember, the birth constitutes a small fraction of the time you'll spend with your children.

    July 24, 2010 at 23:11 | Report abuse | Reply
    • Ituri

      Angela, while correct in a way, its still also wrong to expect others to choose how women give birth by estimated tiny risks. The latest birth research shows there are complex chemicial reactions that happen during labor, which are skipped during a Csection, which could have further reaching impact on the baby than we expect, healthwise. Demanding a woman have Csection just because she's had one before deprives her AND the baby of these things.

      July 25, 2010 at 11:45 | Report abuse |
  10. Homeschool Mom

    Read "Obstetrical Myth vs. Research Reality." VBACS are generally the safest route, and the risk of a elective c-section compared to a vaginal delivery is identical for breech babies (if your OB has been trained to deal with them.) Stay away from hospitals and OBs if your pregnancies and general health are normal. The legal climate dictates medical practice and OBs are too few to allow labor to move along naturally and slowly. Pictocin is another plague on women and a standard in most labors these days. Once you accept intervention, you'll need more intervention.

    Just say "No!" to an epidural and episiotomy after you have prepared yourself for an unmedicated delivery. To avoid unnecessary interventions: take Bradly childbirth classes and hire a doula if you're stuck with a hospital or hospital attached birth center. Otherwise find a free standing birth center if you don't birth at home.

    Have an undrugged birth at home with a midwife. They don't do episiotomies and there is no dictated pushing that leads to tearing. Keep your body in tact. The tear rate is less than 2% with a skilled midwife and the vast majority are shorter than episiotomies. My midwife has attended deliveries with dozens of women delivering 10-12 lb. babies with no problems. The hospital transfer c-section rate with my midwife is 1 in 80. Depending on the hospital you choose it is generally around 1 in 3 or 1 in 4. The hospital transfer rate with my midwife is 1 in 40.

    My first at home. The second was a hospital transfer c-section for a placental abruption. You CAN transfer safely if there are complications. Talk to your midwife about the complications she has handled and how. Interventions are only good when necessary. If you need them, thank God for them.

    July 25, 2010 at 12:45 | Report abuse | Reply
  11. s

    As a physician my first duty is to care for my patients. But equally important duty is to protect my financial viability – protect my medical license, protect my ability to earn a living and support my family. I look at the society around me which dictates how much risk I can tolerate.

    I will never do something that exposes my patient to risk. I will also maximize my effort to protect my earning capacity and not lose my license. I really do not give damn about what any body else things, they will never interfere with what I need to do.

    July 25, 2010 at 13:12 | Report abuse | Reply
  12. s

    To Home school Mom

    In spite of all that you say – modern medical science and practice is what has brought down maternal and child mortality. I lost my grand mother in a child birth and a brother in still birth. Ask around, my story is not uncommon. Go to third world countries where they have at home/midwife deliveries and find out what happens.

    July 25, 2010 at 13:15 | Report abuse | Reply
  13. Dee

    Women didn't used to die at a rate of 1 out of 3 without c-sections; that is the current c-section rate in some places (where I live it's 25) and it's unacceptable. Learn how to do something besides slice and dice.

    July 25, 2010 at 15:26 | Report abuse | Reply
  14. Dee

    K, I'm so sorry what happened to your son and to you. But it has nothing to do with Vbac, except that if women cannot vbac in a hospital they may unfortunately choose to vbac at home, and I think that's what you're saying would be a bad idea.

    July 25, 2010 at 15:28 | Report abuse | Reply
  15. Stephanie

    I would gladly try to have a VBAC. I had a c-section after being induced because there wasn't much movement going on. After two days of nothing going on the doctors suggested that I have a c-section because he probably wasn't going to come down on his own. At the time it was the best option for us. Now looking back I regret that I didn't get to hold my son immediately after he was born. I would love to try to have a VBAC with my next child whenever that may be. I'm glad that I will get that option. And by the way whoever was talking about infant mortality–you are aware we have one of the worst infant mortality rates in the world. In the world–we fall behind what some people like to call third world countries.

    July 25, 2010 at 22:01 | Report abuse | Reply
  16. US Medical Resident

    I think people missed my point, but this is because they are somewhat narrow minded. My point was not to convince people into one way of thought or another, but rather to point out what is the truth about modern US medicine. There are two approaches – population based and individual based. The mothers who know better and cherry pick their information and data thinking that this is how science is validated do not understand because they simply do not have the background to understand what valid scientific studies are and how to critically evaluate them. This is the same idea as the mothers who know better than the medical community and still insist vaccinations cause autism and refuse to vaccinate their children. They cherry pick data, ignore other studies and choose the individualized approach to medicine. They are entitled legally to do so. In this case, I do take a stance because the overwhelming evidence suggests that the vaccine autism link is not real. Moreover, the risk to the general population of these disease coming back and harming other people and the very children that these know it all moms think they are protecting makes this problem even more grave. I will cite a particular circumstance where the lack of knowledge of these moms really harms innocent people. A pregnant mom may be exposed to a mother and her children who do not believe in vaccines and become infected with rubella. This pregnant mom can then be infected and the rubella virus will cross her placenta and cause congenital rubella disease in her unborn child. Is this fair? I would argue not, but many of the people who argue so strongly about VBACs without having a serious grasp of the risks and having a rational, personal conversation with their OB (not midwife, who I am sorry to say simply does not have the background in medicine and science to truly understand obstetrics like an OB), does themselves a disservice (and their family as well). Thats ok though, you are more than entitled to do whatever you all want, but you have to live with your choices and potentially your regret as well. These are not meant to be scare tactics. All I am saying is make informed decisions with people who actually have been trained in medicine and science. Contrary to the belief that many have pushed this past year, most doctors are NOT out to get you. If you really think that becoming a doctor is all about the money and this is all we care about, you are sorely mistaken! There are MUCH MUCH MUCH easier ways to make money than becoming a doctor.

    Lastly, as to the personal above who said I am 43 and if I fall through the cracks with mammo, so be it...That is your choice and you are entitled to make that. That said, many many people do not agree with that concept (including me). If we can use modern medicine to prevent cancer in these women, I am personally all for it regardless of false positives. When you see patients dying from cancer like all doctors see at some point in a career, it makes you want nothing more than to prevent patient agony.

    July 26, 2010 at 06:04 | Report abuse | Reply
  17. Kimberly

    To the US Medical Resident: please get over yourself. It is that self-righteous, pompous arrogance in medicine that is so intolerable and turns so many people to alternatives. Just because most of you in medicine worship each other doesn't mean the general population has to join in too. I hate to break it to you but doctors aren't gods and they already have far too much power in society.

    July 26, 2010 at 10:46 | Report abuse | Reply
  18. Anita

    I had emergency C- Section because I was carrying twins. Daughter was in breech position while son was normal. At the same time my friend was also carrying a single baby. She wanted C-Section because according to her "She will get additional two weeks of vacation time for a C- Section". This is also an angle we need to look into.
    Only in US one gets 6 weeks (for normal birth) and 8 weeks (for C-Section) off from work. While other countries provide much longer time off. These days vacation time off is also a factor for working women (who are covered by insurance). How about that?

    July 26, 2010 at 11:43 | Report abuse | Reply
  19. brent

    pompous arrogant God like syndrome jerk doctors: sounds about right to me. Don't worry your pretty little head rings a loud bell as well. What kind of medical system puts everything ahead of natural childbirth. How about booking a section on Friday cause the Dr. doesn't work on Saturday. US medical resident, you know nothing, you are narrow minded, you have no grasp of bedside manner. Your background in medicine and science is crap when you consder the results. You think patients can see God in your eyes you self deluded ego maniac. you break the hypocratic oath on a daily basis and feel good about what you do. Don't post your drivel, we have heard it before, we don't like it, you have to do better, get in touch with your constituents. Again..your bedside condesending manners make me ......sick.

    July 26, 2010 at 12:47 | Report abuse | Reply
  20. Sophie

    US medical resident. Regarding your comment:


    I would like to state that I am an English midwife who trained for 4.5 years (and 2 degrees) to become a midwife. Midwives do have medical and scientific backgrounds. We may not understand obstetrics like an OB, however it could be argued that you do not understand natural childbirth like a midwife? For example how many completely normal, spontaneous, low-risk, not on the bed, no drugs, no forced pushing, no CTG births have you conducted? I may have not actually performed a c-secion but have assisted at many. Whereas MANY Ob's only comlete a few normal deliveries as described above. Your thinking is always for the complications, which I do not blame you for. There are definately times and places for intervention but sadly these days there is far far too much of it. What people seem to forget is that having an elective c-section has great risks to the mother and baby just in itself (ie, infection, bladder and bowel trauma, bleeding, TTN etc). Whereas a VBAC if monitored closely can have a far less risky delivery.

    I understand peoples concerns with law-suits etc but also looking at the current defensive practice of rising c-section rates, inducing rates, greater intervention when it is simply not required etc are actually more harmful to the greater population.

    Also regarding informed choice, women get alot of their information through their Drs and maybe it is the Drs who are 'cherry picking' the infomation they give? How unbiased is the information they are actually being given?
    I give an example. When I came to this country and took my son for his 6 month check was told he would need Hep B shots. This is not common practice in the UK at such a young age as Hep B is a bloodborn virus and extremelly unlikely for a child to get it. But taking the Drs advice I took it, however when changing my son's pediatrician on discussion he told me that there is evidence to suggest the vaccine loses its efficacy after about 15 years and surely that is when they would need protection against a STD? When I asked why is it given then, he just shrugged. If I had been given such information at his first check i would not have taken it.

    July 26, 2010 at 15:35 | Report abuse | Reply
  21. US Medical Resident

    Midwife: You certainly have a place as do alternative providers, but you all need to be held to a similar standard as western traditional practitioners are held to each day. Science is not perfect, nor is medicine, but we do the best we can to try to make decisions based on evidence. Unfortunately, many alternative providers are not held to the same standard, they have no one to answer to and they have an increased risk to do harm to patients compared with traditional providers. If you want to deliver babies, you should be trained to handle the vast majority of cases. Patients are counting on you. If you tell them it is going to be OK up to the point where you realize the birth complication is now outside of your control and requires a transfer to a hospital, it may be too late for the baby and/or mother.

    To tackle you hepatitis B virus (HBV) question...we vaccinate because the patients who have the highest risk of becoming chronic carriers of HBV are those infected when they are younger. HBV is transmitted by body fluids – including blood. This means that the child could be sexually inactive and still potentially become infected (though the risk is admittedly low). The problem is the being chronically infected with hepatitis B greatly increases one's risk for developing liver cancer – an often fatal disease. Is it really worth it to you to take that risk for your child just to make a point about vaccinations?

    To Kimberly and Brent – both of you seem to misunderstand what I am saying. The reality is that there are two ways of dealing with medicine – personal care and population care. Let me give a simple example: there is a disease called Familial Adenomatous Polyposis. This is a disease where there is a near 100% chance of developing colon cancer by about 40 years of age. If we screen everyone at birth for this disease, we could catch those with the disease and remove their colons prophylactically (to prevent cancer). This would cost a lot of money though and so it is not done. It is rare enough that it is not worth the cost. That said, colon cancer after 50 is not a rare occurrence and so it is recommended (and often covered by managed care) to have screening colonoscopies at 50 to remove pre-cancerous lesions before they become cancer. This is a great example of personal versus population based medical approaches. This is not arrogant to state that these two different methods of practice are out there and that they oppose each other in principle.

    So, this leads me to believe that you think it was arrogant for me to say that patients should not rant and rave (without any real knowledge about vaccines) about how vaccines cause autism and then encourage people to not vaccinate their children. Instead of answering this as a doctor, I will answer this as a parent. Who are you to decide to put other peoples' children at risk? Where did you get your education to think that you are right, medicine and science is wrong and you are so willing to bet that you are right that you will not only bet on your own childrens' lives, but that you will risk the lives of other peoples' children as well? If that is not arrogance, I do not know what is. Not only is it arrogance, but it is selfishness and blatant stupidity.

    Do I think I am god? Absolutely not. I make mistakes. I am human. Do I know everything (or even close to it) about medicine or science? No. However, I try really hard to learn as much as I can. Lets use another analogy. If my car broke, would I be so arrogant to think that I knew more about it than the mechanic and that I could fix it better? Would I go on a rant and rave about the evil selfish arrogant mechanics when they claim to know better than me about the car? If I did, that would be stupid. He or she has spent years training to know cars. I have no formal training.

    If anything, I think it is the know it all conspiracy theory people out there who need to get over themselves. Not everyone is out to get you. My goal in my career is to help people and make them feel better – not to run around and pretend I am god. Oh and for your information, I have excellent bedside manners. I run into people like the two of you all the time who have their conspiracy theories about doctors and I simply bury my personal feelings about them to do the best amount of good for them without doing harm. That is my job, so that is what I do.

    July 26, 2010 at 21:45 | Report abuse | Reply
    • dismayed


      This paragraph neatly sums up the main problem with the state of prenatal and childbirth care in this country. The medical community views pregnant women as "broken cars" that need to be fixed.

      Obstetricians are trained to fix problems. They are a wonderful asset to our society and save tens of thousands of lives every year through advances in medicine. Most of them don't know beans about "normal birth" though. They see a problem to be fixed, a riddle to be solved through the correct sequence of interventions, drugs, and surgeries.

      An obstetrician is as necessary for a normal childbirth as an ASE Master Mechanic is for adding air to your car's tires. Which isn't to say there isn't a place for either of them – thank goodness they're available when something really *does* break.

      July 29, 2010 at 17:27 | Report abuse |
  22. US Medical Resident

    oh and one more thing about the HBV losing efficacy :

    1. That is what booster shots are for
    2. I had HBV series and still have positive titers

    July 26, 2010 at 21:48 | Report abuse | Reply
  23. Kimberly

    To U.S. Resident: I don't have any conspiracy theories and I don't think doctors are out to get me. They couldn't be bothered, they're all too busy being in love with themselves. You say, "the reality is", that's YOUR reality, not everyone's. You make absurd assumptions. I never said one way or the other my personal feelings on vaccines. I am talking about being a patient and you rant about cars and mechanics. I do not see that as a good analogy for what I was talking about at all: I am simply a person who has been very ill and who has been very abused by many doctors who have had no soul or compassion or kindness in them anywhere to be found. I have learned first hand about the type of person that it takes to become a doctor: namely, someone who can be utterly ruthless. You said in reference to your less than admiring patients, "I simply bury my personal feelings about them...." Gee, how big of you!! How patronizing as well!! Do you think your patients don't pick up on the fact that you 'secretly' don't like them or their feelings or the way they feel about medicine or their illness or the medical profession in general? You are sadly mistaken because, believe me, they are picking up on all those negative feelings you have towards them. Your response only proves my point, your letter further illustrates your blind arrogance. You may think you are a great doctor, most doctors do think just that about themselves and maybe you are ...who knows? Maybe you are the exception to the rule. However, if you are like most doctors out there, you are a pompous ass who will die never knowing it. Furthermore, don't talk down to me because I am not a doctor and don't have a medical license. I have a B.A. in English Literature from a reputable university. Does that make me a genius or special in any way or an expert about medicine? A resounding NO but I think it could mean that I'm not a complete idiot so I'll thank you not to be so patronizing about my formal education. I may not be a doctor but I have been a patient many times and that, I feel, qualifies and validates my opinion! You forget that being the patient is %50 of the equation! One doesn't have to travel to the moon to be an astronomer and I think my observations about doctors are right on target. You said the word 'stupid' many times in your response. You believe anyone who disagrees with you is stupid then? How doctor-like. You lack the main quality that could perhaps make you a great doctor someday: humility! But I've no doubt all my words are wasted on you. No doctors wants to believe they've wasted all that time and money only to discover at the end of the road that they really hate sick people. Doctors have for far too long been given carte blanche in the U.S. and it's high time they all had a reality check.

    July 27, 2010 at 00:52 | Report abuse | Reply
  24. US Medical Resident


    I am sorry that you have been sick and that you have come across doctors that have not been pleasant to you. That said, I am sure you have come across some who are not like that. Similarly, I am sure you have come across other people in other professions who are also less than pleasant to deal with or maybe even arrogant.

    As I also said in my posts, I am not perfect, I make mistakes and I am not arrogant. I said that numerous times, but it seems that you have an unshakable belief that we are all arrogant, money hungry people who care nothing about our patients. You simply ignored what I said and honed in only on words (which by the way are out of context) to make your case against an entire profession. When I say stupid, I do not think anyone who disagrees with a doctor is stupid. When I say stupid, I mean when someone makes a decision assuming that they simply know better because all docs are out to be as quick as possible or to make money or whatever reason people think doctors are motivated by in practice. The vaccine question is a great example. There are people out there who will scream at doctors about not knowing the facts and about doctors pushing vaccines to make money for themselves or pharma or whatever and that pediatricians are pushing autism. The stupid part is incorrectly believing these ideas puts OTHER PEOPLE at risk. That is not fair to OTHER PEOPLE.

    As for my analogy of the mechanic, the idea is that I am not trained in car mechanics and I will not falsely lead myself to believe I know more than the mechanic. Similarly, you probably have a better command of the English language than me. No doubt, you could go back and correct all of my grammar or write a much better piece of literature than me. You are trained and I am not. That is division of labor. We cannot all be experts in everything. You may know about your own disease to some level, perhaps from learning from doctors or more likely (since many people do this) reading on the internet, but the facts probably go much deeper. The arrogance on the patient's part is to assume they know better.

    Now, you disagree with my assertion that the reality is... do you disagree that there are both personal and population based approaches to medicine? What is wrong with that concept?

    Lastly, your comment that people see through my feelings and that I bury my feelings about patients who disagree with me....allow me to clarify:

    There are patients who disagree with me or my colleagues/attending physicians all the time. I do not have negative feelings towards them. My negative feelings are towards those who think that we are out to get them, who go around telling everyone that docs dont care about patients and are only out to make money, that docs want to spread autism, etc. Those conspiracy theorists are the people that I have an issue with, but that does not stop me from respecting their wishes, being patient with them, advocating for them to the best of my ability and respecting patient autonomy at all times. One cannot be an effective and compassionate doc if our biases are taken into the examination room, operation room, ER, etc. We all strive to check our biases at the door, whether or not the patients do the same or not.

    One last example of people spreading misinformation about doctors without any knowledge about what they are preaching to the unsuspecting masses. During the Obama campaign against medicine, (prior to directing the attention of the reform bill towards insurance and pharma), Obama went on national television and made the comment that doctors make decisions in a way to make themselves money and not in the patients interest (because of the fee for service plans). He claimed that when a kid comes to the doctor (which would be a pediatrician) with a sore throat, the doctor would opt to take out the tonsils rather than treat it with medicine. First of all, pediatricians do not do surgery. Second, if the child was referred to a surgeon, they would not make any money on the operation (the surgeon would). Third, there are protocols in place to determine when conservative medical therapy fails and when surgery is needed. The pediatricians would go by these protocols and their clinical judgment and have no financial incentive to move to surgery. It is about patient safety. If the president of our nation does not understand how medicine works (and is a harvard educated attorney), is it fair to say that obtaining information from people within the field is sometimes helpful?

    July 27, 2010 at 06:41 | Report abuse | Reply
  25. Sophie

    US medical resident:

    FYI – Midwives in the UK are trained in a medical and scientific manner, we only work by evidence based research and our membership is upheld by two regulatory bodies, where midwives have to prove continuous learning and clinical practice. We are expected to work within specific guidliness (just as Drs are). I know that it is the same for American midwives.
    Midwives in hospitals in the UK work ALONGSIDE their medical colleauges and are considered the experts in 'normal birth' whereas Drs are the experts in obstetric complicatiions.
    Midwives are also completely competent in caring for woment throughout their pregnancy, childbirth and puerperium as long as they remain low-risk without any need for a Drs consultation. Midwives are competent and responsible practitioners (we are not the herb growing, tree hugging "alternative practitioners" that you seem to think). Have you ever worked with a midwife? I would advise you too as you may actually learn something about natural birth and not interfering unless required.

    Another point for you to consider is that the actual 'traditional' birth providers are midwives.

    Midwives are trained to deal with all aspects of birth and if anything goes outside the norm will refer to a mediacl colleague.

    Are you trained in all aspects of birth? as I said before, how many babies have you delivered that are not on a bed, CTG on, in stirrups, and foced pushing? Can you honestly say you are an expert in that area of giving birth?

    Patients count on you too, if Drs insist on inducing labour for no good medical reason is that safe practice? it is common knowledge that inducing labour can lead to further interventions and an increased risk of instrumental delivery (and more harm to mum and baby).

    As to the HBV point, I agree Hep B is a serious fatal condition, but how many sexually active babies are there? if the main shots reduce their efficacy at 15, why not wait until then to give them? I am not against immunisations. My son has had all the recommended shots, I am just asking questions which is my right as a parent.

    You seem to have a real chip on your shoulder and I think thats very sad. Anyone in the caring profession (Drs, midwives, nurses, etc etc) should care about their patients and take ther considerations on board. I agree that you cant please evey patient, midwives too have difficult patients, but it is our duty to provide care for all women and give them informed choice. The majority of women we care for are adults and fully able to make informed decisions and it is their right to do so.

    You seem to have a real chip on your shoulder about alternatice practitioners

    July 27, 2010 at 11:47 | Report abuse | Reply
  26. Kimberly

    To Resident: There is nothing wrong with your grammar, that is not the problem. I agree with some of what you say but a lot of it, I just don't agree with at all. My beliefs are not just some spontaneous 'unshakable' ideas that popped into my head one day. My beliefs are based on years of experience and observation. It is not arrogant for patients to contend that they know more about their own bodies, certainly they know more than some doctor they have just met. Yet, doctors will often display astonishing arrogance in just such a situation and insist that they know best, often to the patient's detriment. Doctors may sincerely believe that they check their biases at the door but I have never experienced such altruism on their part. I am 50 years old (not that old, relatively speaking) and will likely not live that many more years because of doctors' mistakes caused by their arrogance and refusal to listen. If I should meet a decent doctor before my time is up, I'll be sure to let everyone know....but I won't be holding what is left of my breath. I, of course, don't know you. Perhaps you are a very good doctor but there's just too much overwhelming evidence out there that doctors are, in general, truly awful, selfish, greedy people who put profit ahead of human life. Keep in mind that you are a resident and still very idealistic. I don't wish to crush anyone's idealism but I think, in time, you'll discover that medicine doesn't work the way you seem to think it does. I have been around the world of medicine, as a patient, more than you have been as a doctor. Long-time patients observe and learn plenty about the way the world of medicine works and it isn't pretty, especially here in the U.S. where, unfortunately, profit is all that matters most of the time.

    July 28, 2010 at 08:23 | Report abuse | Reply
  27. MedRes


    I respect your opinions, but I feel as though you have a chip on your shoulder about doctors. In fact, I would argue that your persistent and sweeping assessment of doctors (most or all of them) suggests that it may be you that has preconceived notions. That is fine, but you must realize that this is your opinion. Moreover, you seem to almost attempt to persuade me to go down the very path you seem to have such a disdain for – specifically, you push the idea that I am young and naive and that in time I will become like all the rest. This suggests to me that you may have an unshakable perception about doctors. Again, that is fine, but I think you may not be so open minded. This may be a reflection on your health and the experiences that you have had with doctors, and I am very sorry for your suffering, but it is still opinion. I have met plenty of docs out there who truly care. Sure, there are bad apples, but there are some good ones out there. There are bad people out there in all kinds of lines of work – does this mean you should assume that all humanity is evil?

    As for medicine = profit, there are many other, simpler, better ways to make money without so much effort and sacrifice. We go through a lot to get to the point where we practice medicine independently and effectively. Now, does medical care cost too much? Perhaps. This is more of a political debate, but unfortunately, all things cost money and everyone wants the best care, the best equipment, the best medicine, the best surgeries, the best technology, etc etc. Recall that when Senator Kennedy was being treated for his cancer, he went to a top ranked research institution for his care. He did not go to an inner city or rural hospital to see the local oncologist. He is the advocate of universal, sustainable health care, but when push came to shove, he got the VIP medical care that a less wealthy or powerful patient would have not received.

    This is why I commented above about individual versus population based treatment strategies. Personally, I think people are individuals with their own uniqueness and their own medical needs – not statistics. I believe in more screening, earlier intervention and prevention of disease. I believe in promotion of healthier living earlier so that it does not have to come to the amputation (in diabetes) or the coronary bypass or the invasive colon cancer. I know this means more cost to the system, but this is where my idealism comes into play. You are right in that I am young and idealistic. I want the best for each patient. This is something that is not sustainable. Hence the problem where costs spiral out of control and a suture costs 200 dollars (to the patient or insurance) when it really is only worth 10 dollars (if that). I do not have the answers to this question at this point in time. I dont know if anyone has any real answers – I think most of it is based on ethics, politics and philosophy. There seems to be very little objective points about this subject.

    That said, the next think people do is turn their sights towards doctors. They think that because doctors have high salaries, they are the cause of the high costs of health care. Perhaps this is partially true, but it is not entirely and the problem runs much deeper. For example, why should it cost hundreds of thousands of dollars to become a doctor? It this is truly meant to be a altruistic field, why does society allow such outrageous costs to train? Why does it impose such work hours on the doctors? Why does it impose so much pressure about litigation when we are all totally aware of the human flaws of every doctor. All docs make mistakes – we are human just like everyone else. So on the one hand, people say that docs should stop being so arrogant and realize they are not always right and do not know everything. On the other hand, if they are wrong, they can be sued for hundreds of thousands to millions of dollars. Please explain this interesting paradox.

    Lastly, you said that through observation, you know more than a doctor about disease processes. Again, I would suggest that this may be arrogance on your part. Surely you can pick things up along the way, but where do you pick this information up from? Either health care providers or off the internet/media/books/tv/etc. Some of the things you can observe, but how do you observe cancer inside of you? How do you observe high blood pressure (that lurks for years before a stroke sets in)? How do you observe the plaque in your coronary arteries until symptoms set in? This is where you turn to doctors. The studies done before are where we get our information. This is what we base our training and practice on. What do you base your information on? If it is from what you are told – who tells you? Doctors, nurses, etc or some random article on the internet? We all learn from somewhere and in the case of medicine, personal observation has its limitations.

    July 28, 2010 at 20:02 | Report abuse | Reply
    • PBD

      Nice writeup, MedRes. I'm sure you are far to busy to have spent that kind of time writing it. Take it from an old fart like me- if people don't understand basic science and statistics, all the logic in the world will not suffice and you're better off either appealing to them on a more emotional level or doing what you need to and then moving on. Life is short and there are lives to save and people who will appreciate your skills, and that's why you do what you do. Don't attempt to convince the ones who don't want your help.

      July 30, 2010 at 11:17 | Report abuse |
  28. Kimberly

    MedRes: I respect your opinions as well and your detailed feedback but I get my information mostly from my own personal experiences and observations. That's where most people get their information and how they form their opinions. We can all only go by our own experiences. What else is there really? You believe what you believe, I believe what I believe, I think that's pretty much it. I wish you well in your practice. I guess I can never hide my great disappointment in doctors. I agree that docs are overworked but when they make a mistake, it's far more serious because it can result in death, that's the paradox. Lastly, perhaps I am arrogant, perhaps this means I should have become a doctor! My handwriting is certainly bad enough.

    July 28, 2010 at 22:09 | Report abuse | Reply
  29. Brenda

    Everyone is talking about percentages as if they were only numbers. What if you are the one with the "bad outcome?" What if you are the one that delivered the baby that died due to complications, despite clearly outlining why you are not a good candidate for VBAC? My husband was involved in such a situation during his residency and it is not merely a percentage to him. Does he do VBACs? Yes, he does. Has his experience shaped the way he approaches them? Yes, it does. There are still doctors out there who do care about the patients they see, enough to let them know both the benefits and risks. Ultimately, yes, the choice belongs to the patient, but please don't be so stuck on "natural" childbirth, that you completely ignore medical counseling. Use it to make a wise choice, either way.

    July 30, 2010 at 00:31 | Report abuse | Reply
  30. PBD

    I love the headline. "Vag. births after c-section usually okay." Usually? Usually is not good enough. One baby with problems and the liability to the hospital is enough to shut down the hospital's maternity service permanently. Hospitals already offer it as a civic duty and to offer complete packages to insurers- most of them do not break even on maternal and pediatric care. VBAC's generally are safe- I've had one myself and taken care of dozens of women who did wonderfully. But the day that 1% chance occurs- and it will, if not to me, then to another doctor- that'll be the end of our maternity service, because the hospital will not be able to afford it after the jump in the premiums. Good thing there's another hospital in town that won't allow VBAC's, so my patients and I will have a place to go. For now.

    July 30, 2010 at 11:09 | Report abuse | Reply
    • dismayed

      C-sections are "usually" ok too. Is usually not good enough in that case as well?

      July 30, 2010 at 13:38 | Report abuse |
  31. The OC

    My complaint is that hospitals won't stop pushing for a mother to get an epidural and pitocin. The two together don't mix and eventually the heart rate of the baby goes down and a c-section must be performed. That is what happened to me. My baby's heart rate was fine up until they started playing with the pitocin and the epidural...I think ALL hospitals and ALL obgyns should be sued for being so careless!!! I wanted a natural birth and instead I got an emergency c-section due to the damn pitocin!!! It is a pain in the ass to find an obgyn that will perform a VBAC...They should all be ashamed of themselves.

    July 30, 2010 at 12:43 | Report abuse | Reply
  32. maryjane

    I had my first baby by c-section – 6 years later, had my second baby VBAC – no problems which swayed me to VBAC for the third baby (eight years later). During labor (thank God I was at the hospital) my uterus ruptured which could have caused my daughter and/or I to die. I would not take that risk again, but thats just me.

    September 15, 2010 at 02:41 | Report abuse | Reply
  33. Neaddyperve

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    October 3, 2010 at 17:16 | Report abuse | Reply
  34. Bliceance

    Новые ссылки на тему, как похудеть.
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    October 14, 2010 at 09:21 | Report abuse | Reply
  35. Teestsowlouct

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    January 11, 2011 at 04:20 | Report abuse | Reply
  36. Nurse

    I'm glad that I've found your thechart.blogs.cnn.com blog. I think that you are a specialist at your field! I am going to launch a website soon, and your blog will be very useful for me... Thank you for all your efforts and wishing you the success in your business.

    March 16, 2011 at 19:04 | Report abuse | Reply
  37. Poetry


    April 6, 2012 at 10:48 | Report abuse | Reply
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