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Wednesday
Sep142011

Bringing Back the VBAC

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By ANaturalAdvocate

 

Image courtesy of Transforming Maternity Care


Vaginal births after Cesarean (VBACs) are an important part of the question surrounding the rising Cesarean rate in the US. While many organizations support access to VBACs, they are still elusive for many women. Transforming Maternity Care published an article by Amy Romano on Monday that begins:

If evidence supports VBAC as a “reasonable option” for most of this population and indeed the better option for many, it is time to be reasonable about how to make VBAC as safe, accessible, and satisfying as it can possibly be.

Unlike many recent articles about VBAC, this one doesn’t discuss whether VBACs are safe (although it does link to many resources regarding the safety of VBACs and various studies regarding them). Instead, this article deals with building a “quality framework” for increasing access and care. 

Romano lays out three basic steps in building such a framework:

  1. Help more women make and implement choices that are informed by the best quality evidence and aligned with their own values and preferences.
  2. Maximize the proportion of women planning VBAC who experience uncomplicated vaginal births.
  3. Provide the best possible response to obstetric emergencies including uterine rupture.

Each of the steps are supported by information about the rationale for the step, a description of the current approach, why the current approach is not sufficient, and another approach that might be better suited to achieving the goal of more access to and more successful VBACs.

Romano’s article is unique in that it lays out clear steps, supported by links to evidence, for “bringing back VBAC.” While she acknowledges that VBACs may not be available - or even appropriate - for all women, the focus is in increasing access, giving informed consent, and allowing women and their providers to participate in a discussion to provide best care. 

After you have read the article, what do you think about the steps Romano lays out? What about the other approaches she suggests would increase access and provide better care for women? Have you seen any of these approaches in action?

 


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Reader Comments (6)

I think this is an issue not just limited to the United States - this is anecdotal but in the last few years here in Jamaica every woman I know of (family/friend/acquaintance) who had a Cesarean Section before and got pregnant again, the doctors decided to do a Cesarean again. From what the ladies' said it was almost like it was done as if its a given, a necessity. Never thought any more about it until I read this.

I going to be reading through this website more to educate myself on this issue. I want to be a father someday, better start learning from now. :-)

Jevaughn Brown

September 14, 2011 | Unregistered CommenterJevaughn Brown

Jevaughn, I'm going to assume the link after your signature was just an automatic thing, but it's kind of spammy to link to something not pertinent to the post. Thanks.

September 14, 2011 | Unregistered Commenteremjaybee

No no I always put it under my name when I leave comments as my signature since that's my personal website.

September 14, 2011 | Unregistered CommenterJevaughn Brown

I'm glad to hear more discussion about the third step in this discussion, better response to ALL obstetric emergencies, instead of focusing on just uterine rupture. Having been a nurse for 10 years prior to becoming a midwife, I have seen the poor response capable in a small community hospital to any obstetric emergency. On off hours, there might be only ONE anesthesiologist for the entire hospital. This was the case in my last employ where we delivered 300-400 babies a year. If we had an emergency when someone else was having an appendectomy at 3 in the morning, we waited, sometimes up to the magical "30 minutes" for the other anesthesiologist to get there. Small community hospitals use this scenario to say they do not have the resources to employ an anesthesiologist just for the OB floor and they, therefore, cannot do VBACs. I have always asked myself, no shouted to myself, "What about all the other OB emergencies?" If you can't handle uterine rupture, you can't handle other OB emergencies, and therefore you shouldn't have an OB unit! This need for "readily" or "immediately" available emergency response has been the smoke screen for preventing VBACs in many hospitals for many years.

September 15, 2011 | Unregistered Commenterjoycnm

I think we primarily have a VBAC access problem here in the USA. If all women with previous cesarean deliveries were given the complete set of unbiased facts and stats about VBAC and RCS in non-alarmist language and then supported fully down either path by their providers, I'll bet half of them would choose VBAC. Then we wouldn't need the US DHHS's Healthy People 2020 objective of increasing the VBAC rate from 9.2% in 2007 to 18.3% in 2020.

From Amy Romano's post:

"The AHRQ systematic review researchers emphasized the need to incorporate “non-medical factors” in prediction tools to enhance their usefulness. These factors, which include liability concerns, the nature and extent of informed decision-making, and provider and birth setting characteristics, appear to have a stronger effect on VBAC likelihood than factors intrinsic to the woman."

In my experience working with dozens of women in my local ICAN group, this concept rings especially true. When a woman selects one of a handful of providers (OBs and midwives) in my area who are TRULY pro-vaginal delivery (and have the liability insurance that "allows" VBAC), her chance of having a successful VBAC is very high regardless of the reason for her previous cesarean section or her personal characteristics.

September 15, 2011 | Unregistered CommenterKK

I am having my second VBAC in a month... Is it true that once you've had one successful vbac that your chances are even higher for subsequent VBAC's? Also, do you rec'd any links in regards to repeated VBAC's? Thanks, Deb

October 1, 2011 | Unregistered CommenterDeb
This blog is all done!
Thanks for wanting to comment. This is an archive of a blog that once was. Take care! Jill