Thursday, March 11, 2010

A Midwife’s Take on the NIH VBAC Consensus Conference

by William F. McCool, CNM, PhD, CRNP, FACNM

This past week the NIH held a 3-day Consensus Conference examining the current situation in maternity care regarding vaginal births after cesarean (VBACs), which have diminished considerably in number over the past 10 to 15 years. I was able to attend, and urge everyone to read the consensus preliminary report. In addition, many news outlets have picked up the story, including The New York Times.

Midwifery was well represented at the conference. Midwife and ACNM President Melissa Avery was in attendance, as was ACNM Executive Director Lorrie Kaplan. Tina Johnson, ACNM director of Professional Practice and Health Policy, spoke eloquently to the NIH assembled panel during the Q and A session. Certified nurse-midwives (CNMs) Mary Barger and Judith Rooks also raised important issues for the panel to consider. CNMs Cathy Emeis and Mona T. Lydon-Rochelle were featured speakers who presented VBAC data to the panel. Most impressive was Tekoa King, midwife extraordinaire and deputy editor of the Journal of Midwifery & Women’s Health, who was one of the NIH panelists.

I felt that the conference was quite good, and the meeting was as close to “fair and balanced” as it could get, which is not always the case with these NIH conferences. The bottom line is that the panel believes VBACs need to be offered to women as a part of informed consent, and that the opportunities for VBACs need to return to where they were in the mid-90s before ACOG and other groups began cautioning women about this method of birth. Much more research needs to be done regarding outcomes, and as pointed out by several speakers, any change in policy will require some form of tort reform in order to remove fears of litigation from those practitioners involved in VBAC care. But all in all, this NIH statement is hopefully the start of reversing the trend away from VBACs.

Nice work, all you midwifery and birth advocates in attendance!

Hear more from Dr. McCool at the ACNM 55th Annual Meeting & Exposition.


Babies In my Head said...

I was unable to locate a position or opinion on birth center VBAC in the concensus statement. Are you aware of any discussion on the topic?

Heather Bradford, CNM, ARNP said...

Thanks for giving the update Bill. I am so glad so many midwives were there wearing different hats and representing us well. Good on you all!

Anonymous said...

This is a great benefit for women. I would like to see ACNM develop a patient handout that can be used to counsel women in language that really helps them understand the risk of repeat C/S versus the low likelihood of uterine rupture.