Regarding Rob Stein's Nov. 24 front-page article "Once a C-Section, Always a C-Section? Wom- en Who Want to Try Labor on Later Deliveries Are Increasingly Refused":

As an obstetrician who practices on Maryland's Eastern Shore, I fought to retain the option of vaginal birth after Caesarean (VBAC) for my patients, but I was unable to continue to provide this service. Policy statements from the American College of Obstetricians and Gynecologists and published articles recommend that an operating-room team be "immediately available" for women undergoing a trial of labor. Our hospital cannot afford to keep an anesthesiologist, a scrub nurse and a circulating nurse on duty for a labor that might take hours or a day.

Further, in Maryland a VBAC malpractice lawsuit has never been successfully defended. One can talk about a 1 percent risk of uterine rupture, but I know of a case in which a uterine rupture occurred and a team was immediately available; five minutes after the infant showed signs of distress, it was delivered by C-section. At the time I was congratulated by the father on the speed and responsiveness of the team, but when the child developed cerebral palsy, the family filed a lawsuit.

I believe in the principle of autonomy in medical ethics.

The woman's fear that she would be cut open against her will is unfounded; to perform surgery without a patient's permission is assault. However, people also must understand that it is unreasonable to ask a physician to perform a procedure that puts both patient and doctor at risk.



American College

of Obstetricians and Gynecologists

Easton, Md.