NIH Post VBAC Conference Consensus Statement

March 12th, 2010

Following the 3 days of meetings and discussions between the National Institutes of Health’s Consensus Development Program, various obstetrical experts and birth advocates on the viability of vaginal birth after cesarean section (VBAC), the NIH has released a consensus statement highlighting the key points from the discussion,  where they believe subsequent research needs to focus and their recommendations to obstetricians about how to approach the subject of VBAC with their patients.

Here is a summary of the consensus statement.

  • The panel affirmed that a trial of labor (TOL) is a reasonable option for many women with a prior cesarean delivery.
  • Rigorous research shows that a trial of labor is successful in nearly 75 percent of cases, and maternal mortality is actually lower for women who have a trial of labor, regardless of whether they end up delivering vaginally or by cesarean, though those women who have an unsuccessful trial of labor and undergo a repeat cesarean delivery experience higher morbidity than those who have a successful VBAC.
  • Concerns have arisen because although VBAC does reduce morbidity in mothers, there is a slightly increased risk of morbidity and mortality to the fetus. The Panel is asking for more research to see if these disparities can be resolved and definitive risks determined for both mother and baby.
  • The panel is advocating for additional research to develop clear, evidence-based risk assessment tools to assist mothers and providers in the decision-making process from early pregnancy through delivery, accounting for individual risk factors, values, and preferences to see who is an appropriate candidate for TOL and VBAC and who is not.
  • The Panel strongly recommended that policymakers and providers collaborate in the development and implementation of appropriate strategies to address malpractice concerns that may keep providers from recommending VBAC, such as increases in malpractice premiums and threat of litigation in the event of untoward events.  These factors and others seem to be (along with other factors) exacerbating barriers to TOL  for women with a previous cesarean delivery.
  • The Pannel recommends that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess the requirements to have an obstetrician and anesthesiologist “immediately available” while any woman who is having a TOL is laboring.  This recommendation has created a significant barrier to TOL and VBAC for many hospitals who cite the cost of having an obstetrician and anesthesiologist constantly on call is prohibitive. They ask the societies to compare VBAC risk relative to other obstetrical complications of comparable risk, risk stratification, to see if it is truly necessary in light of limited physician and nursing resources.
  • The Panel recommends that Healthcare organizations, physicians, and other clinicians should consider making public their TOL policy and VBAC rates, as well as their plans for responding to obstetric emergencies. This will help the providers and patients better assess if a TOL really is a viable option for their situation.
  • They  recommend that hospitals, maternity care providers, healthcare and professional liability insurers, consumers, and policymakers collaborate to develop integrated services that would reduce or even eliminate barriers to a trial of labor and subsequent VBAC.

The full NIH Consensus Statement is available Here.

Policy makers need to hear from us if we want to have choices in how we give birth to our children. I am in contact with many advocacy groups and will share your concerns. Please add your comments to the panel discussion in the comments section.  ~DTL

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