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Thread: Birth After Caesarean Study

  1. #1

    Join Date
    Feb 2003
    Location
    Melbourne, Victoria, Australia, Australia
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    Default Birth After Caesarean Study

    Check out the Birthrites website for full details - http://www.birthrites.org

    Birth After Caesarean Campaign

    At least 11 hospitals throughout Australia are currently recruiting pregnant women whoíve 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 babiesí 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 Motherís 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 hospitalsí 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 womenís 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 babiesí 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 donít 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 womenís birthing choices after caesarean, contact the campaign manager at: [email protected].
    Kelly xx

    Creator of BellyBelly.com.au, doula, writer and mother of three amazing children
    Author of Want To Be A Doula? Everything You Need To Know
    Follow me in 2015 as I go Around The World + Kids!
    Forever grateful to my incredible Mod Team and many wonderful members who have been so supportive since 2003.

  2. #2

    Join Date
    Oct 2003
    Location
    Forestville NSW
    Posts
    8,944

    Default

    I've just sent an email to find out more as there are a few hospitals around us in the study.

  3. #3

    Join Date
    Mar 2004
    Posts
    1,547

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    I noticed this morning at my hospital appointment that my hospital, Redcliffe Hospital, are involved in this. In the poster it said they are looking for women who either plan to have a VBAC or are planning a repeat c/s.

    I noticed they are also doing a study on when is the best time after 37 weeks for twins to be born and whether it is better to induce, have elective c/s or wait to start labour naturally. I don't know how they are working the study but it sounds along similar lines to the c/s one - they want women who don't really have a preference or who 'don't care' how they give birth and then want to stick them in one of the categories. It is a worry and I can already picture an outcome where it is found that it is better for twins to be born via c/s, because the women who are induced or labour naturally will end up with multiple interventions and then get a c/s anyway.

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