Grassroots Network: NIH Consensus Development Conference on VBAC

Dear Friends,

As most of you know by now, the National Institutes of Health (NIH) convened a Consensus Development Conference on VBAC (vaginal birth after cesarean) in Bethesda, MD on March 8-10, 2010. I felt privileged to represented CfM and be one of the voices for consumers, trying to keep the focus on what is best for women and babies rather than the concerns and pressures that hospitals experience.

It was clear that many of the presenters really understood the problem of VBAC bans, especially Rita Rubin who gave a powerful presentation of women's stories. There was plenty of frustration, too, especially near the end when the panel ethicist refused to acknowledge a pregnant woman's right to refuse surgery, even when she has appropriately weighed the risks to herself and her baby.

All in all, I think the conference really moved the VBAC conversation in the context of other problems in maternity care. It remains to be seen just how much medical practice - and culture - will change as a result of the panel recommendations.

This Grassroots Message includes CfM's response to the NIH Consensus Report on VBAC. At the bottom, I've included links to the NIH conference documents, media coverage. Happy reading! Citizens for Midwifery on the 2010 NIH Consensus Development Conference on VBAC

Our overall assessment of the NIH report can be found below and links to much of the media coverage below that. A full analysis can be found here.

The NIH panel recommendations urge two courses of action that, if implemented, would go a long way toward improving the situation for women with prior cesareans. They state that their goal is to "support pregnant women with a prior transverse uterine incision to make informed decisions about TOL [trial of labor] and ERCD [elective repeat cesarean delivery]". To do that, they (1) urge evidence-based practice, and they (2) urge ACOG to reconsider "ACOG #5". CfM agrees. We would also like to see the following actions:

* All hospitals and OBs should start supporting VBACs, not just "offering" and "encouraging". CfM believes the Midwives Model of Care represents that support of physiologically normal birth.

* ACOG should rescind "ACOG #5" immediately. In doing so, insurance companies would no longer have a basis for dropping or threatening to drop malpractice insurance or raising insurance rates on practitioners and hospitals that offer VBAC, as those individuals and institutions will merely be responding to both the evidence and the guidelines. By rescinding "ACOG #5", ACOG and its members would be taking a step toward earning back the trust and confidence of the women they serve.

* Informed consent must be based on an honest risk assessment, including information about provider outcomes, provider bias and conflicts of interest, as well as the research evidence, in order to support all women, not just VBACing women, to have healthy births.

Willa Powell

CfM President

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The NIH documents can all be reached from their press release, including the full report, the full evidence report, and recorded webcasts of the conference:

http://www.nih.gov/news/health/mar2010/od-10.htm

There has been a great deal of news coverage, including:

http://www.nytimes.com/2010/03/11/health/11birth.html

http://www.npr.org/templates/story/story.php?storyId=124542025

http://www.msmagazine.com/news/uswirestory.asp?ID=12295

Many organizations are developing press releases and responses including ICAN and Lamaze:

http://ican-online.org/print/node

Lamaze

A running blog discussion from the conference can be found at

http://thefeministbreeder.com/once-a-cesarean-rarely-a-choice

http://thefeministbreeder.com/nihvbac

and several blog postings with ongoing discussion can be found here:

http://www.theunnecesarean.com/blog/2010/3/10/nih-vbac-consensus-development-conference-gift-horse-or-troj.html

This article anticipated the NIH conference and very much supports CfM's philosophy:

http://www.nytimes.com/2010/03/07/health/07birth.html?partner=rss&emc=rss

A fairly comprehensive list of articles on this conference is available at:

http://birthaction.org/Blogs/tabid/66/EntryId/64/Articles-and-blogs-on-the-NIH-VBAC-Consensus-Panel.aspx

There's even a petition: http://www.petitiononline.com/VBAC2010/petition.html