Saturday, July 11, 2009

From the "Marsden Wagner is eating my brain and all I got was this lousy t-shirt" file

What is safe?

We -- I'm talking about doulas and CBEs and even midwives -- teach our clients that if they end up at the hospital, and a doctor or CNM suggests an intervention, to ask, "What are the benefits? What are the risks? Is it safe?"

My boyfriend Marsden writes:

Since every medical procedure or technology has side effects and risks, no technology is 100% "safe." In every case, it is necessary to balance the chance of a good result (efficacy) with the chance of a bad result (risk)... But the decision as to whether the good chance outweighs the bad chance should not be made by the doctor, who is taking no chances, but can only be made the person taking the chance -- the woman. Therefore the doctor can never say that any procedure is "safe" but only tell the woman the chances and let her decide.

I'm going to think about this the next time someone asks me if a particular intervention or procedure is safe. I tend to think of "safe" as interchangable with "risk," but they're completely different. For example, I usually cite the BMJ study and say that homebirth is safe, but the real result is that homebirth outcomes were similar or better than hospital birth outcomes for low-risk women. To me, that means that homebirth is as safe as hospital birth -- which I'm allowed, since it's my opinion -- but that isn't fact.

This really becomes an issue for VBACs, where there are risks for VBAC and risks for a repeat c-section. There are slightly more risks for single-layer incisions, and less risk for double-layer incisions. Is VBAC safe? I think so. In my opinion, the risk of uterine rupture is less than the risk of surgical complications. But many women disagree, and schedule a repeat c-section. I tend to blame the doctors or others for over-emphasizing the risk of uterine rupture, but nevertheless, safety comes down to opinion.

I've seen some homebirths where the baby or mom needed intervention -- actually I've seen more homebirths like that than nice normal easy homebirths -- but I still think that homebirth is safe.


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