Birth After Caesarean Campaign
At least 11 hospitals throughout Australia are currently recruiting pregnant women who’ve had a prior caesarean to participate in a Birth After Caesarean (BAC) study comparing birth outcomes for Vaginal Birth After Caesarean (VBAC) with Elective Repeat Caesarean (ERC). While women have the option to choose how they plan to birth, information regarding the study clearly seeks to encourage women to leave their babies’ births to chance by participating in the portion of the study which is a Randomised Controlled Trial (RCT).
The following hospitals are collaborating in this trial:
Townsville Hospital, Queensland
Caboolture Hospital, Queensland
Redcliffe Hospital, Queensland
Toowoomba Hospital, Queensland
The Mater Mother’s Hospital, Brisbane, Queensland
Lyell McEwin Health Service, Adelaide, South Australia
Modbury Hospital, Adelaide, South Australia
Royal North Shore Hospital, Sydney, New South Wales
Nepean Hospital, New South Wales
Women's and Children's Hospital, Adelaide, South Australia
Specific concerns Maternity Coalition has regarding the BAC trial are:
1. That consumer concerns raised in November 2002 have been ignored by the researchers and the collaborating hospitals’ Human Research Ethics Committees (HRECs).
2. That consumer advocacy groups were not consulted by the HRECs which approved the trial despite NHMRC recommendations to do so in relation to research on women (Human Research Ethics Handbook, 2001).
3. That the researchers presume to show what is best for women when care should be based on women’s individual needs.
4. That the study design is significantly flawed and unethical given that:
Participant information sheets contain inaccurate and incomplete information on the risks and benefits of each mode of birth.
Healthy pregnant women with uncomplicated pregnancies are being actively encouraged to participate in the randomised controlled trial (RCT) arm of this study (there is also a patient-preference arm) despite the fact that they may be excellent candidates for VBAC.
The majority of participants will be reluctant to leave their babies’ births to chance, so it is likely the RCT will not attract enough women to be considered scientifically valid.
Women who are committed to achieving a birth outcome will be excluded from the RCT. ie, the only women who will participate in the RCT don’t care how they give birth. This means that the RCT does not take into consideration the influence of motivation and other psychological factors.
The RCT arm of the trial puts an unfair burden of participation on vulnerable women who lack enough information and social support to make an informed decision based on
their individual needs and wellbeing.
There is inadequate research to assess psycho-social factors contributing to birth outcomes after caesarean or to assess the best models of care for vaginal birth after caesarean. Therefore some obvious gaps in the research that should be addressed prior to subjecting women to major surgery have not been thoroughly examined.
Women in the VBAC groups may be put at greater risk of harm and disadvantage because of the imposition of unnecessary routine interventions during labour, fragmented care by birth attendants who may not necessarily support normal birth after a previous caesarean or clinicians who have high intervention and caesarean rates and low VBAC rates.
The only women who will agree to be randomly allocated to surgery or VBAC will have no strong preferences for how they birth, women in the VBAC group of the RCT may therefore lack motivation and information on how to optimise their chances for a straight-forward vaginal birth.
Inconsistencies in administration of the trial are unavoidable in each VBAC group. The nature of the Doctor/Midwife:woman relationship dictates that women in the VBAC group will be influenced by the attitudes, opinions, preferences, practices and experience of attending obstetricians and midwives and these will vary greatly. Whereas, caesareans will only be performed by qualified surgeons with little variation in practice or technique.
The last RCT which demonstrated many of these flaws, The Term Breech Trial, had a devastating impact on the way in which women birthed despite the fact that study design flaws and faulty analysis have seen a call for the original recommendations to be withdrawn. Despite this, the lasting impact of this research may continue to affect women and their families well into the future.
For further information about the campaign to prevent an unethical and poorly designed research trial from negatively impacting on women’s birthing choices after caesarean, contact the campaign manager at:
bac@maternitycoalition.org.au.
