Despite an abundance of cautionary statistics and research the rising trend of surgical birth persists. The overall increase in cesarean sections is due in part to the decline in Vaginal Birth After Cesarean (usually abbreviated VBAC) at an all-time low of 9.2 percent in 2004 (13). A woman who has a primary cesarean section has a greater than 90 percent chance of having a subsequent cesarean delivery. A policy statement published by The American College of Obstetricians and Gynecologists (ACOG) in 2004 recommended a surgical team and anesthesiologist must be available twenty-four hours a day in order for VBAC to be safe. Many hospitals who fell short of this criteria were choosing not to allow women to attempt VBAC within their facilities because they could not provide 'immediate' surgery if needed. Although ACOG issued a revised opinion in 2010, encouraging autonomy for women in their maternity care decisions and affirming that women with a previous cesarean are candidates for a trial of labor; the trend towards repeat cesarean persists.
A large number of physicians continue to feel that the risk of uterine rupture (developing a tear in the wall of the uterus) that accompanies VBAC is too high and that an elective or scheduled C-section is the best option for any mother who had the surgery for a prior pregnancy. Yet Cesarean delivery is associated with increased risks for adverse obstetric and perinatal outcomes in the subsequent birth including malpresentation, preterm birth and unexplained stillbirth. Some of these risks may be due to confounding factors related to the indication for the first cesarean (23). Cesareans are inherently riskier than normal vaginal birth, but repeat cesareans carry even higher risks. Evidence is growing that scars in the uterus which accompany cesarean surgery can cause placental abnormalities that endanger both mother and baby in future pregnancies, and that the risk of these abnormalities increases dramatically with a subsequent cesarean (8).
It is critical that women and clinicians make informed choices, balancing the risks and benefits of cesarean delivery in first and future births. We gather to shift the conversation beyond facts and research toward increased provider/patient responsibility and effective advocacy for Vaginal Birth After Cesarean.
The conference will convene an audience of up to 260 participants in Miami, FL. Participants will include parents and consumer groups, activists, doctors, midwives, doulas, students of all these professions, and interested parties from a wide range of other disciplines. For those who are unable to atend the conference in person, the conference may also be available by webinar.
NIH Consensus Development Conference:
State-of-the-science statement on Vaginal Birth After Cesarean intended to provide health care providers, patients, and the general public with a responsible assessment of currently available data on vaginal birth after cesarean (VBAC).