Posts Tagged ‘consensus’

March 9th, 2010

NIH VBAC Day 1

While I wanted to be the first Blogger to have my live coverage up from the National Institute of Health VBAC Conference today, between a toddler and 9 month old, dinner, cleaning, and working on moving furniture out of the house for our delivery tomorrow, I can’t say I will be the first. Oh well, housework happens right?  I neglected it enough today.

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.