First Day of the Conference, part 2.

On the first day one of the other sessions was, “Can VBAC’s Make A Comeback In The US?” by Dr. Eugene Declerq. (please understand these notes are not exact quotes)

*He asks “whats the link between research, evidence and practice? NONE. It’s about cultural practice. That is what is determining what the numbers are.”
*5 things you might not have known about contemporary VBAC’s:
1. Things are maybe not so bad for vbac’s. there is a tendency for vbacs to be under counted in vital statistics systems. *same is true for repeat cesareans. Because on the birth certificate there isn’t an option for vbac, only vaginal or cesarean. So technically the vbac counts as a vaginal. This changes how the numbers are reported. Alabama ranked number 4 in the lowest vbac rates.
2. The falling rates of VBAC have nothing to do with maternal risks. Simply having had a prior cesarean is the only indicator.
3. The relationship between vbacs and primary cesareans. The debate over vbacs is not extinct from the debate. Increasing the VBAC rate will likely be related to decreasing the primary rate. (primary=first time cesarean).
4. Is there a trend toward home VBACs? Yes.
5. Things will get better for vbac’s. How much worse can they get? (sadly, this is true) NIH meeting, new ACOG guidelines.
*NIH reports that mortality is higher in ERCD (elected repeat cesarean delivery).
*Uterine rupture: 325/100k women undergoing TOLAC (trial of labor after cesarean)
ERCD-26/100k (Risk increases with the number of prior cesareans). (can’t find the year or study name on this one.. although I think it was in the green journal).
Interestingly enough this session was a tad bit depressing. Because what would have to change is first, how vbacs are reported, but also this has a lot to do with cultural practice and if a doctor has had an adverse outcome or not. Also, the insurance companies and malpractice insurances are going to have to reform before you see more acceptance of VBAC’s. Even though ACOG made some recommendations that were to be a help to those wanting a TOLAC, they still made recommendations (in their own Level C.. based on “expert opinion” not RCT’s) that are not based on the evidence (RCT’s). So at the end of the day the hope is that things get better because, how could they get worse? Oy.

Here is a video that Dr. Declerq has done on “Birth by the numbers.”


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