I Went to the NIH Consensus Development Conference on VBAC and All I Got Were These Lofty Goals

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:

  1. Develop a “NIH Consensus Statement Primer” to help women use the consensus statement to their advantage.
  2. 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.
  3. 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:


The Primer

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


The Conference

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.

The Alliance

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.

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  1. TheFeministBreeder

    Those are some awesome goals, and nothing too far fetched, I don’t think anyway. I SOOOOO want to be a part of that coalition aligning birth activists and providers. But you know what the NIH conference inspired me to do?

    1. Get pregnant.
    2. Get my CCE
    3. Get my law degree

    (all things I was already planning to do.) It pretty much just confirmed to me that I’m on a path that I’m good at, a path that needs me, and a path that seems to have an important future.
    .-= TheFeministBreeder´s last blog ..March: The Month of Gina =-.

    • BirthingBeautifulIdeas

      @TFB – Yay for wanting to get involved in that coalition! Seriously, I think that this could be a great strategic move for birth activists/advocates. There’s this wild part of my brain that thinks we could use the coalition itself to advocate for a midwifery model of maternity care (and an explanation of how I think that could happen would take a whole ‘nother blog post).

      And I am totally psyched that the conference confirmed your commitment goals and plans for yourself. You are going to be such a fantastic CCE and attorney! (And from what I can tell, you are already a fantastic parent.) Excited to see where your (definitely) important future takes you!

  2. Shannon

    I love your coverage and thoughts…

  3. Courtroom Mama
    Courtroom Mama03-15-2010

    I think that this is awesome.

    I have one concern about the conference to create a new bioethics of pregnancy. See, I think that the SAME ethics should apply to pregnant women as to all other adults of sounds mind. If you think about it, what Dr. McCullough is calling for is an ethical framework specific to pregnancy, namely, one in which pregnant women have only circumscribed rights. This is a problem. I hope that makes sense.

    Also, I hope that people will consider the plaintiffs bar in conversations about the medicolegal atmosphere. We talk a whole hell of a lot about having multi-party talks that include all the stakeholders, and yet I have yet to see anybody ask malpractice attorneys about why things are the way they are from their end. As I commented on the AcademicOB, malpractice attorneys consider themselves to be fighting for women. I’m not sure they’re wrong.

    At the conference, they kept saying it was like the “elephant in the room” and I just kept thinking about that parable with the three blind men who were feeling an elephant, and the guy who’s holding the trunk says it’s like a snake, and the one with the leg says it’s like a tree, and the one with the tail says it’s like a switch from a tree. How the heck can we expect to get it right if we’re not getting all the information?!

    Keep up the energy, and I’m right there with you!
    .-= Courtroom Mama´s last blog ..Why is VBAC a vital option? Because anything less is anti-woman. =-.

    • BirthingBeautifulIdeas

      @Courtroom Mama – I think we’re on the same page re: pregnancy ethics, actually. Dr. McCullough’s view of pregnancy autonomy, rights, and ethics are pretty far from where I’d like to go (though I suppose his would be an important voice to include in such a conference). But it seems that Dr. Lyerly was looking to develop an ethics that reinforced the autonomy, rights, and personhood of pregnant women. Sadly, it’s almost as if we need to create a pregnancy ethics in order to dig ourselves out from centuries of paternalistic views of the pregnant woman.

      As far as the tort reform goes, I would love to keep your specific perspective in the mix. You seem to hit the nail right on the head in so many ways on this topic (love the analogy, by the way). In all honesty, I know relatively little about the law in this area. But I am concerned about changing people’s (read: care providers’) minds, and I think that a good way to do this would be to form this sort of alliance. I’ll explain it in another post sometime, but I almost view it as a guerilla method to getting some serious change in maternity care in the United States. :-)

  4. Molly

    I could probably help with #s 1&2 if you decide to move forward with them. (3 is outside my waters, though certainly not something I find unimportant). By the way, UNC Chapel Hill may be a reasonable place to try to have such a conference; I’m thinking of the UNC Hospitals’ volunteer doula program and excellent lactation services/research, the university’s active Women’s Center, the community’s broader birthwork culture (freestanding birth center, midwives, doulas), and UNC’s and Duke’s feminist scholars. Though I expect there are lots of places with the same assets where I didn’t happen to do my grad work and give birth …

    • BirthingBeautifulIdeas

      @Molly – I would love your help. You were actually one of the first people I thought of when I considered organizing such a conference.

      Also love the idea for UNC Chapel Hill and agree that it would be a good intersection of the various groups I’d like to bring to such a conference.

      Oh my goodness, this is so exciting…and overwhelming! :-)

  5. uberVU - social comments
    uberVU - social comments03-16-2010

    Social comments and analytics for this post…

    This post was mentioned on Twitter by PushforMidwives: RT @kristen_bbi: I went to the NIH Consensus Development Conference on VBAC and all I got were these lofty goals. http://ow.ly/1kFl1 #nihvbac…

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