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NIH to Docs and Hospitals: Drop VBAC Bans

vbac-nih-guidelines-acog-csectionConcerned that doctors and hospitals are thinking more about legal ramifications, rather than a woman’s health, the National Institutes of Health issued a statement today essentially telling doctors and hospitals to stop banning vaginal births after cesareans.

Instead, a NIH consensus panel recommended that pregnant women and their caregivers use evidence-based decision-making in deciding whether to attempt a trial of labor rather than scheduling a c-section. In other words, enough with the anecdotes, we know you’re putting potential lawsuits ahead of patients, look at the science.

“We are concerned about the barriers that women face in accessing clinicians and facilities that are able and willing to offer a trial of labor,” the panel noted in its draft consensus report.

“We are concerned that medico-legal considerations exacerbate these barriers. We strongly recommend that policymakers and providers collaborate in the development and implementation of appropriate strategies to mitigate this problem.”

For more than a decade, the number of VBACs has steadily declined — some of it by the choice of the mother but also because of barriers set in place by hospitals or doctors who refuse to let their patients attempt labor. Doctors site an increased risk of uterine rupture during VBACs — a circumstance that would endanger both the life of the baby and the mother.

However, evidence has long shown that VBACs under certain conditions are just as safe for delivering a baby as a c-section, which carries with it all the possible side-effects of any major surgery. In fact,  70 percent of women can safely give birth vaginally even if they’ve had a prior cesarean. But few are allowed to even try.

Now, the panel recommends that doctors discuss six specific questions (read them here) with their patients when deciding whether a VBAC could be safely attempted. In particular, the panel asked them to look at the short- and long-term benefits to the baby and to the mother.

Many hospitals around the country banned VBAC, after the American College of Obstetrics and Gynecology issued guidelines which limited VBACs to those hospitals with a surgeon and anesthesiologist on-site. The NIH panel asked for ACOG to reassess this requirement and make it “relative to other obstetrical complications of comparable risk and in light of limited physician and nursing resources.”

While ACOG is generally pleased with the panel’s recommendations, one critic, Shannon Mitchell, director of BirthAction, a Tampa, Fla.-based organization that helps women obtain VBACs, said it fell short since nowhere did the NIH say women had the right to refuse a repeat c-section.

However:

Cathy Spong, MD, chief of the pregnancy and perinatology branch of the National Institute of Child Health and Human Development at NIH, urged the panel to explicitly state that VBAC is a reasonable option for women, noting that the draft report implied that conclusion in several places but did not state it outright.

Back in the 1980s and most of the ’90s, VBACs had been on the rise, thanks in large part to another NIH report showing the once-a-section-always-a-section policy was not supported by science.  Then, the VBAC rate rose from 3 percent to nearly 23 percent at its peak. In 2006, the VBAC rate had dropped to 8.5 percent. It will be interesting to see if this NIH intervention will have any effect on the c-section rate in the U.S., and whether women will no longer have to go to these extremes just to attempt a birth they know is more than likely to have a safe outcome.

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Photo: mediaindependent.com

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