Willa Powell, President of Citizens for Midwifery, gives an excellent summary of the March 8-10, 2010 National Institute of Healths’ Consensus Development Conference on VBAC. She gives this decision as one of the things the NIH got right:

“The Conference panel’s final report states: “Given the available evidence, TOL [trial of labor] is a reasonable option for many pregnant women with a prior low transverse uterine incision.” This is a really important and positive conclusion that we can all use to “encourage” our local hospitals and obstetricians, along with their insurers, to change their policies.”

The NIH recognizes that physicians and hospitals have put up barriers to Vaginal Birth After a Previous Cesarean and recommends that those barriers are eliminated. they were not evidence-based then nor are they are not statistically valid barriers now.

Willa adds recommendations that the CfM would make,

• 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 will 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 rebuilding some 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.

These are accepted practices of experienced midwives around our country. Not every midwife can support VBACs when they work in a hospital that won’t support VBAC or their training didn’t provide understanding of the true safety and risk of VBAC. See a discussion on Informed Consent at VBAC.com
Read the Childbirth Connections article on Informed Decision Making; Informed Consent or Refusal.
Physicians and midwives shouldn’t have to go out on a limb to provide evidence based care. Nor should one ideology be exchanged for another. Assessment and ongoing monitoring are needed while not needing to interrupt the woman’s physiological flow of birthing.

As the Spinning Babies Website is updated later this year I hope to have a more comprehensive section on cesarean avoidance, VBAC success and more information on when and why a cesarean may be needed for lack of progress due to size or fetal position. Drop me a line and let me know what you would like to see covered on the topic of VBAC, cesarean and cesarean prevention.