If you were not able to watch the coverage, you can use these links for viewing of what took place.
Day One of the National Institute of Health’s VBAC Conference
Day Two of the National Institute of Health’s VBAC Conference
Day Three of the National Institute of Health’s VBAC Conference

All three links are video feeds.

The Original Draft Statement
Current Statement after Revising
The final statement should be out within a week or so, until then I will leave the slot for this blank.

The Conference Abstract

In the aftermath of this conference, there are an incredible amount of articles not only addressing the rising cesarean rates, increasing maternal mortality rates, and lack of VBAC access, but human rights issues that the panel at NIH did not address in their statement.
So, because I have been a media junkie the past couple days, I started tracking all the links.

United States urged to confront shocking maternal mortality rates
Too Many Women Dying in US While Having Babies
Doctors Debate C-Section Options
Deadly Delivery by Amnesty International
Women Struggle to Avoid C-Sections
Panel Urges more Choice in Birth after Cesareans
Too Many Preventable Deaths Among New Moms
Group Urges New Rules for Vaginal Birth after Cesarean
Panel Urges new Look at Cesarean Guidelines
NIH Panel : End Bans on Vaginal Birth After Cesarean
Vaginal Birth After Cesarean Underused
Panel : Vaginal Birth after Cesarean not too common
Panel : Women Need a Chance to avoid repeat C-section
Are C-Sections too common?

As more stories come out, I will continue to include the links!

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I am glad that on several occasions through the document they discuss the NON medical factors that are influencing VBAC today.
I would also like to point out that I enjoy their final statement in the end which includes asking ACOG to reconsider their recommendation of VBAC and the “immediate” wording.

I really wanted to pick this all apart much more, but I am going to wait for the final draft for that.

I encourage everyone to read the draft, and submit comments in the next short couple hours to have your voice heard and suggestions looked at!

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Please read, and leave comments, they will only be taking comments for a short period of time today!

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But I will get to that later in my post.

The day started with information on epidural anesthesia, as well as the lack of available anesthesiologists nationally to fill the need of the “immediate emergency care/delivery” guideline. I learned a lot about the national crisis surrounding available anesthesiologists.

1. Epidurals do not cause, or mask symptoms of a uterine rupture, if anything they allow for other options other than general anesthesia in the case of a rupture of need for emergent delivery.
2. When the speaker asked ACOG what they mean by immediate in their recommendation, their answer was “Immediate means immediate” kinda like banging your head against the wall?
3. Rural hospitals, and hospitals in rural areas have lower number of anesthesiologists, meaning lower access to an anesthesiologist in an emergent situation.
4. Currently in The United States, there are less than 30,000 current practicing anesthesiologists.
5. 55% of those anesthesiologists are over the age of 55 meaning they will be retiring in the next roughly 10 years.
6. There is an increase in Woman anesthesiologists, but women are more likely to work part time, or less likely to take on over night shifts, or shifts in Obstetric anesthesiology because of the schedule.
7. 4% of hospitals with in house anesthesiologists have 500 or more deliveries a year.

All in all, having in house anesthesia specifically, and only for Obstetrics, or VBAC is completely unrealistic. Not only that, but one thing that caught my attention of this speaker was the comment that “We need to remove lawyers and insurance companies from this choice” meaning the choice of VBAC vs. elective repeat cesarean delivery.
There was a suggestion at one point that VBAC only be “allowed” at hospitals that have at least 1500 births per year, but unfortunately like the 24 hour anesthesiologist coverage just for VBAC it is simply unrealistic. There are areas of our country that women have a 3 hour drive, or even longer to a hospital of that kind of caliber.
In the end, ACOG blames the OB’s, the OB’s blame the hospitals, the hospitals blame the women… and it is a giant blame game.
We need to stop playing the blame game, and we need to make this an available option for all women, while using the real evidence on its safety!

Moving on to some more things I learned…

1. Placental Abruption & Cord Prolapse are more common than Uterine Rupture.
2. Trial of Labor has much lower rate of perinatal death in women with previous cesareans as opposed to elective repeat cesarean deliveries.
3. In a study, 20% of OB/GYN’s say they reduced their exposure to lawsuits by no longer offering VBAC.
4. The risk of fetal death in a first time mother, is the same as, a mother VBAC’ing.

The last thing there shows a statistical analysis that shows us no difference between a mother VBAC’ing her second child, and a first time mother giving birth to her first child. The fetal death rates are the same. This shows one thing to me, and many others who were also live tweeting during this, women are not being truly informed about all of the risks and benefits of VBAC.  Women are not being given accurate, and real information.

There were several comments about women and their providers needing to be the ones making the decision regarding the mothers choice to VBAC or have an elective repeat cesarean, and some may not agree with me, but in my opinion it shouldn’t have to do with her provider at all. It should be the patients decision, period.

Another part of the survey that made me giggle was one of the reasons cited for women opting for elective cesareans instead of VBAC was to avoid the pain of labor which I have been through twice, also ending both times in a cesarean delivery. Avoid pain? Who are you trying to fool because cesareans certainly are not avoiding pain by any means!

More bits and pieces I learned :

1. 49% of ACOG Fellows in one survey said they do more cesarean sections for fear of litigation.
2. There is more and more clear evidence that women want VBAC but are being denied these services by providers, as well as hospitals.

Then came the discussion of woman’s stories, and what has taken place all over the country to women searching for VBAC as an option. Several ICAN women were quoted, as well as featured which I loved!
Gina also known as The Feminist Breeder was featured, and her struggle to have a VBAC.
Joy Szabo of Arizona who had to drive 350 miles, leave her husband and 3 children behind because of her hospitals choice to ban VBAC after she had already had a VBAC at this facility!  (Joy will be on my radio show tomorrow night at 10pmEST)
The number of women, and their stories were touching, and made the whole experience and conference real it made the panel members, and audience members realize these are real women we are talking about and essentially deciding the future of their childbearing.

In many cases, the question and answer sessions were my favorite part. Although there were a few audience members who continued to get up with their long winded comments sometimes going no where, or no relevance to VBAC at all. Which bothered me because there was a clear line of providers and activists who had short, to the point, and important comments and questions.

Couple comments from the question and answer session which stood out to me :

1. “No one should be brought to the OR against their will or without their consent”
2. “I feel like I am committing a crime when I take a knife to a woman I know has a high VBAC success rate” – VBAC supportive OB working in a hospital with a VBAC Ban

(I promise, I am starting to get to the end)

One of my issues was the discussion on ethics when it comes to VBAC and elective repeat cesarean deliveries. There is such a gray line that is being crossed continually in this country. Women who have Child Protective Services called on them for being a “difficult patient” and that is something we should not be seeing at all. Being a difficult patient, and being an informed consumer should not be something women fear having their children taken because of.
We should not be seeing women rolled into the OR with Sheriffs or court orders.
We should not be seeing women charged with Murder over a stillbirth when a cesarean is declined.
These are real stories!

One last thing that really got me also!
A panel member said something about protecting the rights of patients AND providers… well ya know what.. the rights of the providers are the ones being protected, by these bans, the defensive medicine, women are the MOST venerable ones involved, and that should not be it!

I could sit on my soapbox for hours, so I will stop there.
I hope that the NIH takes this chance to really form a informed and evidence based guidelines and recommendation for this.

We will see tomorrow when they release it at noon!

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While I originally planned to have live and continuous coverage all day, again, life happens, and I did not realize how hard it would be to “live blog” with the time limits, as well as fast moving speakers. While the panel and speakers were on a strict time limit, things move quite quickly.

I was able to “tweet” live and I am going to use all the things I tweeted today to basically write my run down, as well as share some of the many things I learned today. I think after this conference I should have VBAC after my name just for all I know about it. I THOUGHT I knew a lot before this.

1. My day started off tweeting with Amy Romano from Science and Sensibility about the amazing amount of talk regarding evidence based medicine, practice and guidelines for this consensus.
   
2. Another awesome point at the start of the consensus, was the fact that one of the presenters started to discuss the blogging community, She used a screen for her presentation which I believe The Feminist Breeder caught a picture of, and surprised all of us. Yup, you see it right, on the top of the screen is the logo of the popular birth and cesarean section website, The Unnecesarean! I almost peed myself! Along with that is the ICAN logo, and other various PRO VBAC websites.
3. Discussion of placental problems after previous cesarean sections, and the increased risk of more serious and more dangerous placental complications with each cesarean birth.  We have seen in the past 20 years a large increase in things like placenta previa, placenta acretta, and other life threatening placental issues.
4. The risk of hysterectomy also increases, which is rarely discussed. The risk of having a hysterectomy with the 4th cesarean section is 2.5%
5. A quote from one of the speakers included “repeat cesarean section does not eliminate the risk of fetal injury” Which is a huge common misconception of women who are opting for elective repeat cesarean deliveries, also refereed to as ERCD’s.
6. Privately insured patients have higher repeat cesarean rates, and women who have medicaid coverage have higher VBAC rates.
7. 45% of providers stopped providing VBAC services completely due to the ACOG recommendations on VBAC.
   

   Kinda blurry, but my toddler and I watching the conference online

8. White women, are more likely to have a VBAC although African American women have lower risk of uterine rupture or adverse reactions to VBAC.
9. Rural hospitals have lower trial of labor after cesarean section rates, as well as lower VBAC rates, and higher VBAC ban rates. Which is something we all pretty much knew before hand.
10. Induced VBAC success rates are 63%, lower than the over all VBAC success rate of 73%.
11. There was a lot of talk about VBAC outcome prediction tools, which I am not sure how I really feel about them, on top of this, my child decided to start acting up around this point which took me away from the computer for a little bit.
12. Another quote “trying to give women the information they need to make an informed decision” which is what the VBACtivist community has really been saying all along.
13. Countries that use the Midwifery Model of Care have high VBAC success rates. Someone from the audience chimes in “Does that mean we need to move?” LOL!  No, that means we need to get our OB’s to practice like midwives. Ya think we will be able to wrestle the knives out of their hands?
14. Then the first audience question came. And I fell in love with my second, much older husband. Only second to Marsden Wagner. Dr. Suart Fischbein got up, and spoke about liability, VBAC bans, and posed several amazing questions. My heart melted!  I am so glad to have him coming on my radio show in a couple weeks!
15. A friend of mine, Stacey Gregg of New Jersey also spoke, asking questions about racisim in VBAC and medical care, and the panel was very quick to dismiss her, but the worst part was, she had very valid concerns, comments, and questions.
16. Then came my favorite part of the whole day… One of the panel members made a statement about home birth data, and how there really isn’t any, or at least any accurate data and the WHOLE ROOM ERUPTED!  “YES THERE IS!!!!”  Maybe they missed that CDC release last week?
17. When comparing ERCD to VBAC, per 100,000 births, there are 9 less maternal deaths with VBAC than elective repeat cesarean delivery. Hence showing that VBAC is safer, despite all the discussion of risks.  Those are 9 mothers, sisters, daughters that can and should be saved!
18. Now, on to something I was not aware of today… cesarean ectopic pregnancies. Meaning, ectopic pregnancies IN or ATTACHED to the cesarean scar which are deadly!   Something again not spoken of in the risks of cesarean delivery. This happens in 1 out of 200 pregnancies after a cesarean. I wish I had a picture of it as it was fascinating.
19. Another thing I never knew was the increased risk of stillbirth after cesarean sections, and each elective cesarean after!
20. Factors that affect uterine rupture… hmm… right on the slide it said INDUCTION and OXYTOCIN!
21. There was a great discussion on using ultrasounds to look at the thickness of uterine scars and access the risk for a uterine rupture in the weeks before labor.
22. Another great Birth Advocate Shannon Mitchell was able to get up and ask a question.
23. Got to see The Feminist Breeder ask an awesome question about post cesarean emotional impacts.  The panel agreed that there certainly should be more research on the topic itself.
24. Jen from VBAC Facts was able to get up and question VBAC bans and the hospitals that say they are not “equipped” for VBAC. Basically covering and having the panel agree with her about hospitals not being properly equipped is an excuse.
25. You should have seen the look on the faces of the panel when a mother got up and introduced the baby on her hip as a breech HBAC birth meaning, vaginal breech birth at home, after a cesarean.  GASP!
26. Then moved onto the Trial of Labor and the impact on the infants, and again my children started raising hell, so I only got bits and pieces, but I will share what I did get.
27. 2007 marked the 11th year of constant increases in the cesarean rate in The United States.
28. There looks to be a direct connection between the rise in cesarean section rates, and women in the US putting off having children till their later childbearing years. (Interesting graph I will have when they publish the full report)
29. The risk of uterine rupture is 0.8% and the risk for fetal death out of that small percent is only 6%!
30. 1 out of every 3 elective repeat cesarean deliveries takes place BEFORE 39 weeks gestation, when the recommendation is NO elective deliveries before 39 weeks. Showing that providers are picking and choosing which guidelines they want to practice.
31. NICU admission rates in the above babies are higher.
32. Increased risk of Type 1 diabetes in children born via cesarean section.
33. One speaker called ACOG’s current VBAC guidelines “overkill”
34. The same speaker also said home births are not something women should be doing for VBAC’s. Which causes a problem, at least for me. What this speaker/provider does not understand is under the current VBAClash in the country, the ONLY option for many mothers interested in VBAC is out of hospital births, or even UNASSISTED births.
35. Desirre Andrews, the current ICAN President was able to stand up and address the amount of hospitals nationally with VBAC Bans, De facto bans and why women are being forced into alternative birthing options because of these guidelines. She shined like a star!

Now, I would like to add a short disclaimer that all of the above information is NOT information of mine. This belongs to the National Institute of Health’s VBAC Consensus presenters today. These are all studies THEY brought to the table, these are all numbers they they cited, and if you would like further information on ANY of this, you can pre order the full presentation and consensus report on the NIH Website.

These are FACTS that have come from medical professionals, scientific medical studies, and major universities.

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The first thing I want to get out there is a CNM brought up in the question session was home birth, especially for VBAC mothers also known as Home Birth after Cesarean, or HBAC. The moderator promptly made a comment about how there are no accurate statistics for home birth. The room ERUPTED in YES THERE IS!!! And many people continued to speak out about it.

Other great highlights were Dr. Stuart Fischbein being the first person up to the question stand to talk about hospitals who have VBAC bans, hospital policy, and the lack of TRUE informed consent taking place nationally.  He is my hero, and I am so excited to have him coming up on my radio show in April.   Can I add him to the list of men I would like to marry?

Lots of other stuff included the difference in maternal death between VBAC and ERCD’s which out of 100,000 deliveries with previous cesarean sections, 9 out of 100,000 women will die from routine elective cesareans.  Nor are we talking about the serious risks to future pregnancies including life threatening conditions, placental problems, future infertility, etc.

They also tackled the issues surrounding informed consent and how many women are not being given accurate information regarding VBAC Vs. ERCD and the risks involved. Whether for monetary or liability reasons.

There is so much, but once the conference is over tonight, and my husband is home from class, I will be blogging in full.

P.S. The Unnecesarean logo ended up on one of the presenter’s slides!  I was so excited to see that, as well as the ICAN logo right next to it!

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I am starting to watch, and blog and I am trying to get as much onto my blog as I can while following this myself.
I guess it is going to be harder than I though.

First thing I would like to point out is all the women on the panel, as well as all the different backgrounds of the panelists. Nurse midwives, OB’s, etc… A lot of my posts will e bullet points of statements from the conference.

Some appreciations to get familiar with for the next coupe days :
TOL = Trial of Labor
APC = After Prior Cesarean
VBAC = Vaginal Birth after Cesarean
ERCD = Elective Repeat Cesarean Delivery

• VBAC Access is certainly restricted
• Panel is going to look into why the VBAC numbers are decreasing as well as to if these reasons are VALID reasons.
• Lots of emphasis on EVIDENCE based medicine, practice, and research.

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To listen to the show, you can click here : VBACtivists

I was able to call in and share my experience, as well as my opinions on the reason why VBAC is so essential to our maternity care system.

Tune in tomorrow morning for more coverage on the National Institute of Health VBAC Conference.

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