April 14, 2003

Shonky research trial

The Brisbane Future Birth event is on today. Everyone is having a wonderful time and for me, one of the best aspects is having time to chew over various birth related issues with the speakers as we travel from place to place. Yesterday, during a long day getting from Tasmania to Brisbane we had time to talk about a number of issues.

The ACTOBAC trial was one of them. This is a proposed multi-centre, based in Adelaide, that is currently before the National Health and Medical Research Centre for funding approval. The hypothesis to be tested is that babies born via elective caesarean do just as well as babies born vaginally when the mother has previously had one caesarean section. The trial will recruit women who have had one caesarean, whose current pregnancy is uncomplicated and who could be considered good candidates for a vaginal birth after caesarean (VBAC). They will be randomly allocated either to a VBAC or to an elective caesarean and the outcomes for the babies will be recorded.

This is a completely unethical trial, and considerable opposition to its funding is gathering. The trial does not propose to consider the outcomes for the women who may end up with unnecessary major surgery, and assumes that this kind of surgery is a viable, affordable (and apparently safe) option for healthy women. Sufficient research already exists to show that women with a previous caesarean and an uncomplicated subsequent pregnancy have an excellent chance (up to 80%) of having a normal vaginal birth. The Cochrane Library supports this view.

This trial is a blatant attempt by obstetricians to try and prove that a caesarean is a safe way for a baby to be born so they can justify increasing the rate of surgical birth. We’ve been down this road before with the term breech trial that, despite its poor quality, has been used to coerce women into routine surgery for breech births. Like the breech trial, the way the labour is conducted (e.g. the support available to women from midwives during labour, the use of epidurals, inductions etc), appear to be variables that will not be considered. The term breech trial proved that women with breech babies, who give birth in a hospital, with an obstetrician in charge, have better outcomes if a caesarean is performed. It proved that doctors have few skills in facilitating vaginal breech births and that they are only really capable of performing surgical procedures. This is reassuring for those rare times when surgery will save a baby’s life, but is a dismal prospect when so many women are relying on an obstetrician for a normal birth.

This ACTOBAC trial will probably prove the same thing: if a woman has had a caesarean birth in the past, and a doctor is involved in the subsequent pregnancy, your baby may be better off if you have surgery. This trial may once again prove just how inept obstetricians can be with normal birth, and that women should seek alternatives to stay well and healthy.

Meanwhile, while the trial is under way, many healthy women will be denied a normal vaginal birth and may suffer the well known effects of caesarean surgery. Home birth with a midwife may well be the safest way to go if you want a VBAC.

Let’s hope that the NH&MRC see sense and refuse to fund this shonky research.

Posted by andrea at April 14, 2003 08:16 AM

Comments

Hi Andrea: I couldn't agree more with all you've said about this trial. I am so surprised this trial got past the University's Ethics Committee. I am aghast, how did this happen?
Surely women will not agree to be randomly selected to have either a caesarean or vaginal birth! There must be some weakness in our Universities Ethics Committes: I can't imagine a University Hospital in the USA running this trial, for all their reported interventions etc..women's rights are very strong there. It just makes me feel Australian women are being exploited by the/some OBGYN academics. OOps now I sound like a conspiracy theorist, I'm not, but I am really angry about this trial.

marilyn

Posted by: Marilyn Kleidon on April 16, 2003 09:36 AM

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Posted by: fp292003 on January 21, 2004 03:06 PM

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Thers another trial coming twin brith study,i am worried our hopsital will get involved but none of the midwives have been consulted so far-- Pls advise for the etics committee.. how we can stop this..

Posted by: L Sharma on April 24, 2004 09:55 PM