Saturday, March 13, 2010

National Institute for Health Changes Its Statement on Vaginal Birth After Cesarean (VBAC)

The National Institutes of Health (NIH) finished the Conference on Vaginal Birth After Cesarean (VBAC) March 8th-10th, 2010, evaluating issues surrounding VBAC and seeking to quantify why VBAC rates have plummeted in the U.S. over the last decade.

http://consensus.nih.gov/2010/vbacstatement.htm

http://www.ican-online.org/

Clips that I picked from the International Cesarean Awareness Network Synopsis of the conference:

“The final statement from the NIH concludes that a VBAC is a reasonable option for most women. Over 75% of women who attempt VBAC will be successful.” says Desirre Andrews, ICAN President. “Currently less than 10% of women who have had previous cesareans deliver vaginally in subsequent pregnancies, leading to significant and preventable illness and death.”

“NIH took the American Congress of Obstetricians and Gynecologists (ACOG) and anesthesiologists to task, calling on them to change the language in their official recommendations on VBAC. ICAN has understood for years that this language plays a large role in the lack of access to VBAC in the U.S.” continues Ms. Andrews. “We hope ACOG rises to the challenge and also hope they will finally be willing to work with ICAN and other advocacy organizations to improve maternal and fetal safety.”

A survey conducted by ICAN in 2009 showed approximately 45% of hospitals in the United States formally ban VBACs either explicitly or through unsupportive policies and procedures. Many women are never counseled that they are good candidates for VBAC and thus undergo more risky and expensive repeat cesareans. The NIH report acknowledges that this represents a serious breach of medical ethics. ICAN supports every woman’s right to select the care provider, birth setting and birth plan of her choice.

Lacking in the NIH statement is support for a woman’s right to refuse a cesarean section as this was felt to be beyond the scope of the current mandate.

It was acknowledged, however, by many expert presenters that forcing a pregnant woman to undergo an unwanted surgery is medically indefensible, unethical and immoral. ACOG’s own statement on ethics states that a woman should neither be coerced nor punished for not following a recommendation.

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