As a member of the 1980 National Institutes of Health Consensus Development Conference on caesarean childbirth, I read with great interest Dr. Adam Wolfberg’s article, “The C-Section Boom” (October 30). The article is most notable for its omissions. For example, he cites the 1999 opinion of the American College of Obstetricians and Gynecologists (ACOG) that vaginal births after caesarean (VBACs) should take place only in hospitals capable of immediate surgery. But he fails to mention the 2010 NIH Consensus Development Conference on VBAC, which urged ACOG to reassess their recommendation in light of the fact that a number of other potential obstetric complications, unrelated to a prior caesarean, have a comparable level of risk. This conference concluded that a trial of labor is a reasonable option, emphasizing that both an elective repeat caesarean and a trial of labor have risks and benefits.
Nor does Wolfberg mention that ACOG responded by relaxing its guidelines, and now considers VBAC appropriate not only for women with one prior caesarean but also for some of those with two prior caesareans and those expecting twins.
Wolfberg mentions doctors’ fears of litigation if a caesarean is not performed. Surgical risks, when there are no medical indications for surgery, are not only tragedies but also lawsuits waiting to happen.
Beth Shearer / Portsmouth, Rhode Island
Dr. Wolfberg suggests that the rising caesarean section rate might be a serious problem, but he ultimately leaves the reader with a rather ambiguous conclusion. This does a disservice to women and babies.
Wolfberg notes, for example, that it is a “valid” reason to do a caesarean when a mother has had a previous C-section. This contradicts the American College of Obstetricians and Gynecologists, which has issued a statement urging that women be given the option of a trial of labor, allowing for the possibility of a VBAC. The risk of certain life-threatening complications goes up with subsequent caesareans, so this is no small matter.
He also minimizes the risk of caesarean surgery, which, for a significant number of women, results in a hospital-acquired infection that is sometimes antibiotic-resistant and requires repeated hospitalizations. Wolfberg fortunately does suggest ways to reduce the likelihood of a caesarean – such as using a midwife. The chart accompanying his article notes, for example, that Mount Auburn Hospital in Cambridge had a C-section rate of 23.5 percent in 2009, and this is in large part because midwives have attended about a third of the births there. Interestingly, the number of births attended by midwives in that hospital has increased almost threefold in less than a decade.
Judy Norsigian / Executive Director, Our Bodies Ourselves
Gene Declercq / Professor, Boston University School of Public Health
Having actively practiced OB/GYN for the past 47 years, I have been a reluctant participant in this inexcusable and harmful escalation of the caesarean rate. As obstetricians we have come to the conclusion that a flourishing species requires a major surgical intervention a third of the time in order to achieve successful reproduction! How misguided can a medical specialty become?
Dr. Charles Blander / Swampscott
Obstetricians are C-section prone. They learn to cut not for medical reasons but for reasons obstetricians have invented. Wolfberg’s patient in this article is given a C-section partly to avoid annoying his colleague! This is why our C-section rate is so high.
Laurel Charette / Lynn
Mixing it up
Wow, a cocktail recipe in “Mix Mastery” (November 6) calls for “falernum syrup.” I tried to find this locally but was unable to do so. I found a recipe online for making it from “two parts unobtanium extract autoclaved together with ground unlikelium.” Now where am I supposed to get an autoclave?
John Francis Pitha / Dalton
Well, you could go the easy route and buy ready-made falernum syrup at The Boston Shaker (69 Holland Street, Somerville, 671-718- 2999) or Martignetti Liquors (1650 Soldiers Field Road, Brighton, 617-782-3700). Or, if you’re feeling ambitious, you could check out bartender Ran Duan’s recipe now posted at www.bostonglobe.com/magazine. Give it a shot. You won’t even need that autoclave.