I Went to the NIH Consensus Development Conference on VBAC and All I Got Were These Lofty Goals
Have I mentioned anything about that NIH Consensus Development Conference on VBAC yet?
(I kid, I kid.)
I realize that I’ve devoted six consecutive posts to the NIH VBAC conference. That’s a lot, even for an obsessive person like me. But I also really think that the conference was that important.
And before I ride off into the sunset and get back to writing about things like riding crops, lavender oil, and doctors who fail to woo me with their paternalism, I’d like to contribute one more serious thought to the conference and the consensus statement that it produced.
More specifically, I’d like to reveal the three main goals that this conference has spurred me to take on in the coming year(s).
And these goals are big. They’re bigger than anything I can successfully do on my own, and I’d love to request others’ help in accomplishing them.
And that’s because I’m planning to:
- Develop a “NIH Consensus Statement Primer” to help women use the consensus statement to their advantage.
- Organize a conference on pregnancy ethics, primarily to meet Dr. Anne Lyerly’s call for a “more robust pregnancy ethics” but also to respond to the concerning statements about pregnancy, personhood, and autonomy made by Dr. Laurence McCollough.
- Create an alliance between birth advocates and OB/GYNs to work together on tort reform.
I know. It’s as if someone stuck a stick of dynamite under my ass and ten shots of espresso into an intravenous line in my arm and a little fairy next to my ear whispering sweet nothings about the future of birth advocacy.
And if these goals aren’t entirely clear to you yet, here’s my best shot at explaining what I have in mind at the moment:
As I’ve mentioned before (and as others have argued elsewhere), the consensus statement is not perfect. In my mind, the absence of any clear positions on VBAmC (or vaginal birth after multiple cesareans) or the right to informed refusal are serious deficiencies of the statement.
Nonetheless, there is a lot in the statement that women who want to a VBAC or who are even just considering a VBAC can use to their advantage, whether with their care providers, their hospital, their local media, or even their friends and family members.
The authors’ focus on providing transparent and accurate information about VBAC and repeat cesarean to women is of particular importance, as is their emphasis on the significance of the shared decision-making process when it comes to a woman’s birthing options. What’s more, their call for the American College of Obstetrics and Gynecology (ACOG) to reassess their controversial “immediately available” anesthesiology standard gives women an important foundation with which to challenge their local care providers’ and/or hospitals’ “VBAC bans.”
And I, for one, think that it would be fantastic to create a short primer explaining just how women can use this wealth of information to advocate for themselves and their right to choose the way they birth their babies.
So to create such a primer, and to create one that could be an effective tool for change and advocacy, “we” would need to determine (among other things):
- Which parts of the statement are most compelling to OB/GYNs and other care providers
- Which parts of the statement are most compelling to hospitals
- Which parts of the statement are most compelling to the media
- Which parts of the statement coincide with, reflect, or even illuminate a woman’s right to informed consent and informed refusal
- How to make these “compelling” parts of the statement accessible to and usable by most women
During her talk on “The Ethics of Vaginal Birth After Cesarean,” Dr. Anne Lyerly expressed the need for an “ethical framework specific to pregnancy”—one that could accommodate the relatively under-investigated concerns about autonomy, responsibility, decision-making, personhood, and values in relation to pregnancy and birth.
Not surprisingly, the philosopher in me lit up like a round of fireworks at Socrates’ backyard barbecue when I heard her talk about this topic. I mean, I know a thing or two about philosophical conceptions of autonomy and personhood. I even know a thing or two about pregnancy and birth.
And there’s also a part of me that knows a thing or two about organizing and presenting at conferences.
What better way to collaborate on developing an “ethical framework specific to pregnancy” and a “more robust pregnancy ethics” than to start with a conference that brings together those who work in academia, law, midwifery, medicine, and birth-work in general?
The list of resources needed to organize such a conference is a bit daunting, I’ll admit. Off the top of my head, “we” would need:
- A location
- Interested speakers
- An interested audience
- Interested organizers
- Funds, funds, and more funds
Again, the idea is daunting.
But not impossible.
I’d like to preface this section by stating explicitly and without reservation that I would only participate in such a group just so long as its goals and/or actions did not throw women “under the bus” (or the knife), so to speak.
Nonetheless, one cannot ignore the number of times in which conference presenters and audience members mentioned medico-legal concerns and the fear of liability when discussing the current “VBAC climate.” Even if these fears are partly irrational when specifically applied to VBAC, they are real fears, and they are really affecting care providers’ and hospitals’ decisions to refuse to attend and/or ban VBACs.
(For example, although the risk of uterine rupture is approximately .7% in a VBAC labor, and although only 6% of uterine ruptures result in a catastrophic outcome, many care providers’ views of the relative safety of VBAC are overshadowed either by malpractice insurance pressures or by stories of multi-million dollar lawsuits following those exceedingly rare catastrophic uterine ruptures.)
In my mind, it seems as if these fears are so embedded into the way that these doctors approach VBAC that solely “fighting” the fears with evidence-based medicine and/or the consensus statement itself will not be enough to change their policies and practices regarding VBAC.
But fighting these fears with a tempered, woman-friendly tort and/or legal reform might be a significant part of good pragmatic, strategic, and mutually beneficial “solution” to the current “fear of VBAC.” (For what it’s worth, recommending a VBAC consent form in which women abdicate their right to sue following a uterine rupture is neither woman-friendly nor mutually beneficial.)
Returning to the issue at hand, my ears especially perked up during the NIH Conference when Eugene Declercq himself called for birth activists to form an alliance with OB/GYNs to work toward tort reform. Professor Declercq is an incredible birth and maternity advocate who, as far as I can tell, has no reason to engage in “obstetrical apologism” regarding the lack of VBAC access in the United States. In other words, I highly doubt that his recommendation was meant to throw birthing women to the wolves all in the name of the ever-elusive tort reform. And, as should be obvious by now, I’ve taken his recommendation to heart.
Of course, forming and participating in such an alliance and/or coalition will involve some hard and heady work. (For my part, it will involve me getting to know a thing or two more about our legal system!) In fact, the very list of things that “we” would need to do would expand this already expansive blog post into an epic size.
But accomplishing any number of items on that list could have a profound (and positive) impact on birth advocates’ strategies for and ability to effect some meaningful change in the world of maternity care in the United States.