An NIH Consensus Panel has come to the conclusion that pregnant women have been denied the right to avoid repeat cesarean deliveries and should be provided unbiased evidence based information in order to make decisions regarding their ability to attempt a vaginal birth after cesarean (VBAC). The panel suggested that a shared decision making process between the mother and her healthcare provider should be the standard of care, although it recognized that fear of litigation on the part of physicians has exacerbated the barriers that women have faced when attempting to find a healthcare provider or hospital willing to attempt a VBAC.
The panel examined the risks and benefits of offering women the option of a VBAC and concluded that "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".
The panel also identified the need for research into labor and birth practices that contribute to unnecessary first time cesarean deliveries. Given that the overall cesarean rate in Maryland hovers around 33% with one hospital in Baltimore reporting a rate of 45%, reducing unnecessary initial cesarean deliveries could signifcantly reduce the overall cesarean rate, which the World Health Organization suggests should be between 5 - 10% with anything over 15% doing more harm than good for both the mother and the baby.
WIthin minutes of the panel making it's recommendations, the birthing world came alive. Lamaze International issued a statement, birthing blogs like Science and Sensibility and The Unnecesarean had full page accountings of the findings, and representatives of local advocacy groups began emailing. The findings of the panel have the potential to dramatically improve the climate of maternal healthcare.
The excitement is palpable for birth professionals but it should be even more exciting for pregnant women and their families. This may be a first step in seeing some real change and a movement toward mor evidence based practice.
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