Aldo Vacca’s legacy

I approached with interest the comment by Prof Dietz on the legacy of Aldo Vacca (O&G Magazine Vol 17 No 1 Autumn 2015 p55). Unlike Prof Dietz, there were many of us who were privileged to be trained by Aldo. He was an example to a huge number of trainees coming under his watchful eye, in particular with his keenness to supervise (with a dose of Mediterranean ‘cajoling’ along the way). None of us could forget his daily ward-round of the neonatal cots, focusing on the vacuum-assisted babies of the previous day. Woe betide any registrar who was associated with a chignon away from the flexion point, or worse still a ‘failed vacuum’ with successful forceps. We must all remember being gently taken to the nursery to inspect said fetal skull and to account for our actions. I remember to this day the immortal Vacca screensaver ‘It’s always more posterior than you think’, the ‘getting to know you pull’, those cardigans, the attempt at a ‘VeeBon’ and his genuine joy at being presented with a fabulous caricature on his retirement from the Mater Hospital.

Sadly, by the end of the first paragraph, it is clear why this one-pager has been written, as soon as Prof Dietz states: ‘It is a pity Australians don’t realise how big a difference Aldo’s work has made for women in Australia, and it’s even worse that his great work is slowly being undone, now that his championship is lost to us.’ We all have our own perspectives, held with varying degrees of veracity, tenacity and passion; however, their expression needs to be respectful, appropriate and not disguised within ‘sheep’s clothing’. It’s supposed to be about Aldo, a great educator, obstetrician and contributor to international management of birth, not about that which Prof Dietz believes (unilaterally and vociferously) is ‘our irrational obsession with caesarean section rates’.

O&G Magazine could have done so much better.

Dr Aldo Vacca is presented with the RANZCOG Distinguished Service Medal, by the then President Dr Rupert Sherwood and Dr Gino Pecoraro, then Board member, in the Frank Forster Library in March, 2011.

Author’s response

In his letter to the editor, Prof Welsh takes exception to me using the words ‘irrational obsession with caesarean section rates’, and I agree the statement requires elaboration.

There is a great need to debate this topic, which is affecting not just personal relationships and institutions, but our entire profession. Prof Alec Welsh is quite aware of this, given that he is working at the Royal Hospital for Women in Randwick, an institution where this ‘irrational obsession’ was likely the main factor responsible for a tripling of transfusion rates a few years back.¹ Excessive second stages of labour, denial of elective caesarean on maternal request, an emphasis on increasingly risky VBAC and increasing reliance on forceps rather than vacuum are all results of this obsession. I’ve recently summarised the effect of the latter in a review.²

Aldo Vacca’s legacy is the prevention of tens of thousands of cases of major maternal trauma, and his legacy is in danger of being undone. That is blatantly obvious, even if this inconvenient truth conflicts with Prof Welsh’s opinions.

If it took any single issue to convince us that O&G Magazine fulfils an important role, this controversy would surely suffice.

Prof HP Dietz
MD PhD FRANZCOG DDU CU
Professor in Obstetrics and Gynaecology
Sydney Medical School Nepean
Nepean Hospital