Posts Tagged ‘VBAC guidelines’

August 3rd, 2010

New VBAC Guidelines

After being so involved in the National Institute of Health’s VBAC consensus earlier in the year, I, as well as so many others were really anticipating the new ACOG VBAC Guidelines. The decline in VBAC began when they changed their guidelines suggesting only certain women, and certain hospitals were candidates for a Trial of Labor after a previous Cesarean delivery.  We saw a peak in the VBAC numbers in 1996, then a drop consistently there after.

ACOG included in their release something new that previously had been unthinkable in the medical community as a valid option for most women, and that is a trail of labor after two previous cesarean sections. Studies show that it is a safe and valid option for women who wish to attempt a VBA2C, which I have been saying all along.  But maybe now because a huge medical organization with MD after their names says it, people will understand it truly is a safe choice for mothers to make.

Also included in these guidelines are women pregnant with twins, with a prior cesarean delivery, and an unknown uterine scar, which in the past have meant automatic repeat cesarean deliveries.

Just some numbers to include into this also.

In 1970, the cesarean delivery rate was 5%, in 2007 it increased to over 31% of all deliveries with very little improvement to maternal and neonatal outcomes. VBAC was at about 5% which increased all the way up to 28% in 1996. Then the decline started, in 2006 the VBAC rate dropped down to a little over 8%.  Which is horrible for our women here in the U.S.

While I stand by women being informed on making their own choices regarding their care, as a mother who has had two cesarean deliveries, researched, learned the numbers, the risks, and everything involved in VBAC vs. ERCD (Elective Repeat Cesarean Delivery) the risks for a repeat c-section are much higher than a trial of labor after a previous cesarean. You are more likely to have long term complications, be re-hospitalized, need a type of blood product, and all the risks that go along with major surgery when opting for a cesarean over a trial of labor.

The risk for a uterine rupture is between 0.6-0.8% with one previous cesarean delivery, and the most recent studies and numbers has not shown a neonatal death from uterine rupture. I am not sure the amount of years it has been, but per the information from the NIH VBAC consensus, it has been at least 10 years since they have documented a case.

Maternal mortality rates are higher with elective repeat cesarean deliveries over VBAC also. 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!

I think that these new VBAC guidelines are certainly a step in the right direction, while the change may not take place overnight, we are seeing that it is something now being addressed on a large public forum as the backlash of high cesarean rates are starting to take their toll on our women and babies.

February 22nd, 2010

National Institute of Health VBAC Conference

Most of you that already read my blog are not only probably already registered and attending this, but have stellar agenda’s that you will bring to the table, as would I if I was able to find childcare for this mid-week conference.  I came to the conclusion last night, after discussion several different options with my husband that it simply is something I am going to have to pass on, as much as it pains me. This all on top of finding a super awesome roommate yesterday.  Sorry Kristin, I would have LOVED to hang out!

But it is so important that VBACtivists make their way to this.  I think it is way more important than most are realizing.  This will hopefully help to change the tides and attitudes towards VBAC in our birthing community today. With the amount of illegal VBAC bans taking place nation wide, and the lack of access to women, this is truly becoming a crisis in maternity care.

It is no secret to educated women that VBAC is statistically safer than repeat cesarean sections and carry lower risks than a second major surgery, but with one third of all babies being born through major surgery, we are seeing a trend changing to the majority repeating that surgery for all subsequent births.  Right now 90% of all women have elective repeat c-sections, the vast majority for no medical reason.

So what exactly is NIH & this VBAC Conference?
March 8th-10th, in Bethesda, Maryland
the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Medical Applications of Research of the National Institutes of Health will convene a Consensus Development Conference on Vaginal Birth After Cesarean.

They will touch on some very key issues such as :

• What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States?
• Among women who attempt a trial of labor after prior cesarean, what is the vaginal delivery rate and the factors that influence it?
• What are the critical gaps in the evidence for decision-making, and what are the priority investigations needed to address these gaps?

• What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the nonmedical factors that influence the patterns and utilization of trial of labor after prior cesarean?

What happens at an NIH consensus conference?

• At the conference, invited experts will present information pertinent to these questions, and a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality (AHRQ) will be summarized.
• Conference attendees will have ample time to ask questions and provide statements during open discussion periods.
• After weighing the scientific evidence, an unbiased, independent panel will prepare and present a consensus statement addressing the key conference questions.

If you are unable to make it, they will also be offering an internet version, where you can watch live during the conference itself.
I will be doing this will chaotic kids in tow.

For information on registering, you can visit the conference website.
It is FREE!

I hope a lot of the awesome VBACtivists will be attending, I know so far that these awesome women will be there, so maybe just go for a chance to win such awesome advocates?

The Feminist Breeder
Jen from VBACFacts
Desirre Andrews, ICAN President
Kristin from Birthing Beautiful Ideas

I will be looking forward to all your reporting and tweeting!