The NIH VBAC Statement Primer: Inspirations, Goals, and Enthusiasm
Remember way back in mid-March when I returned from the NIH Consensus Development Conference on VBAC with a heapload of inspiration and energy to transform maternity care and access to VBAC in the United States?
I haven’t written much about my goals since then, but this doesn’t mean that the momentum I carried home from the NIH has fizzled out in the passing weeks.
Quite the contrary, in fact.
It’s just that I’ve been doing a lot of “behind the scenes” work. (It should come as no surprise that my goals will take some hefty organizational efforts!)
And as it stands right now, it looks like the first of my goals to materialize will be the “NIH VBAC Statement Primer”–a proverbial “how-to” guide to help consumers use the statement to their advantage.
To explain, the consensus statement has all sorts of amazing potential to transform thoughts on and access to VBAC in the United States. (Simply describing VBAC as a “reasonable option” is amazing enough!)
What’s more, birthing women can and should be a part of this transformation! But we also need to know how to use the NIH statement to fight for this much-needed change.
My hope is that the primer will offer just this sort of knowledge and empowerment to all women who even just consider VBAC as one of their birthing options.
Much to my excitement, lots of other birth advocates, organizations, and bloggers (including Amy Romano, with whom I’ve partnered up for this project) share my enthusiasm over these possibilities!
In fact, just last week, Mother’s Advocate even published on their blog a guest post from me about the NIH VBAC Primer! (Head on over there to read more about my inspiration for the primer, and about our general time frame for this project.)
Until we get this thing written and published–and this may take a while, especially considering that the NIH panel has not yet released their final statement on VBAC–here is a very rough sketch of what we would like to be included in this primer. Please let me know in the comments section if you have any questions, concerns, or other issues you’d like to see addressed in the primer. Again, we want this to be something that women can really, truly use to advocate for themselves and their births!
The NIH VBAC Statement Primer: An Outline
General
- An explanation of the purpose and scope of the primer, and of the NIH Consensus Statement on VBAC
- A definition of the terms used in the statement
Statistics and Research
- An outline of the risks and benefits of TOL (trial of labor), VBAC, and ERCD (as limited to the ARHQ report, the statement, and perhaps the research presented at the conference)
- A examination of VBAC success rates and prediction models
- A brief outline putting all obstetric emergencies (not just uterine rupture) into perspective
Analysis
- Ideal candidacy – How is this term defined in the statement? What does this mean for women who are OR aren’t “ideal” candidates?
- The “immediately available” standard – What is the history of this standard? What were the NIH panel’s recommendations regarding this standard?
- Inconclusive research – What “critical gaps” did the panel find in the research on VBAC? What is the significance of this “inconclusiveness” for women seeking a VBAC?
- Legal rights and protections – What legal rights and protections do all pregnant women have? How does the right to informed consent and refusal apply specifically to women who want a VBAC? How do these rights and protections function in the context of the NIH Consensus Statement on VBAC?
Action
- Advice on “follow-up” local media pitches (e.g. regarding VBAC bans, changing policies and practices, etc.)
- Advice on how to pressure hospitals and care providers to publicize their TOL policies, their VBAC rates, and (for hospitals) their plans for responding to all obstetric emergencies-not just uterine rupture (per the NIH panel’s recommendations)
Advice on using the information in the primer
- Tips on discussing birth options with one’s care provider (or multiple care providers, if one is trying to find a “best fit”)
- Tips on seeking out support and educational organizations
I think this is a fantastic idea and will be a great resource for women, their partners, and the childbirth community in general. A primer that is up to date on the debate, that women can use to educate and advocate for themselves, will be so so useful.
My comments stem from my experience researching and advocating for my own successful VBAC.
1. While it’s important to use the NIH Consensus Statement as your hook, I hope you ensure that the primer itself is framed and presented to women who might be interested more as a *VBAC primer*. Women who are just looking into their options may not have heard about the NIH Consensus Statement so it’s important to assume relatively low levels of knowledge about VBAC.
2. Keeping this in mind, a section on researching providers, with advice and information about how to go about finding the VBAC-friendliest local provider you can, would be hugely helpful (even if just to point women in direction of local ICAN chapter).
3. On the inconclusive research (SO IMPORTANT!) I would love to see something on single v. double-layer sutures, as that was something that was thrown at me and that I researched as much as possible. The fact that evidence was inconclusive was not helpful when trying to convince my husband in the face of an OB who was clearly concerned.
Good luck and I can’t wait to see what you come up with!
Vanessa, your comments make me SO GRATEFUL that I wrote this post! In other words, they are hugely helpful!
I like your idea of framing this as a VBAC primer too–both to broaden the scope of its efficacy and to reach those women who may not even have heard of the NIH Consensus Statement!
I’ll also talk to the person who’s writing the inconclusive research section to make sure that they address the single vs. double-layer suture debate. I know that this is an issue that many women face (often unexpectedly) in their quest for a VBAC.
Great idea! I think it will be very helpful for moms who are wanting or curious about VBACs.
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I’ve already had questions posted on the BBC board regarding the mortality statistics as presented in the NIH statement- namely, neonatal mortality is 3x higher with VBAC. That stat has the potential to completely lose a huge number of women (in fact, I’m pretty sure the mom who posted the question chose to RCS after seeing it),and I would hate for a woman to go in to her provider ready to discuss the NIH findings only to be blindsided with that number. I’d love to see discussion about how small the absolute risk is, as well as how many RCS would be needed to prevent one death, and how much neonatal and maternal morbidity would result from that many c-sections.
This may not have a place in your primer, but I was really surprised to see so much research called “inconclusive” when it seems (to me as a layperson) that the data support a stronger conclusion. It seems particularly odd in relation to neonatal respiratory morbidity, but even in other areas I was left kind of scratching my head, wondering how the data is “inconclusive” when it’s clearly- CLEARLY, I say!- conclusive. ITA with Vanessa that “inconclusive research” is difficult to use persuasively, regardless of the study topic, and I think this is a huge weakness in the NIH statement. I think it’s possible that “inconclusive” as it is used by the NIH is probably different from how you and I would use it in conversation. Addressing that will be important to help women make empowered birth decisions.
I’ll tell you that my biggest fear regarding the NIH statement is that it has just enough lack of clarity to be used to DIScourage women from seeking VBAC. So I’m glad to see you’re writing this, and I hope it helps a whole lot of women choose VBAC with confidence!
These are all fantastic points to address, Pam. You’re right–giving the absolute risk of neonatal mortality during a VBAC (rather than stating that it is “three times greater than the rate following a repeat cesarean) would help to put the numbers into a clearer perspective. I don’t want to obscure the 3x greater risk, of course. I am curious about it, however–even a bit surprised, in fact.
I actually think that a lot of the “inconclusive” data could be used to women’s advantage. So many of the issues that were found to be inconclusive were things that CPs often use to scare women out of VBACs, place unnecessary restrictions on their births, etc. (Epidural requirements come to mind at the moment.) But yes–delineating the difference b/w what a layperson or even practicing doctor would consider “inconclusive” and what a panel of scientific experts would consider “inconclusive” are two very different things!
Kristen, This looks fabulous. Thank you so much for pulling it together and I look forward to seeing, sharing and using the final product.
Amazingly, important work you’re doing.
I am looking forward to working on this with you. Exciting!
OK, back to work…
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I would be happy to look over the part regarding “not so ideal” candidates with Special Scars if you’d like. Just drop me a line whenever you need to.
Thanks, Jessica! You know, we’re thinking of adding a “women’s stories” component to the primer at some point–yours would be PERFECT! I’ll be in touch.
I look forward to utilizing your primer in discussions with my potential providers as I beging my VBAC journey!
Thank you for all your efforts, your pro-activity is insipiring
We want to know what we can do to help with this project. We have a lot of the same items on our to-do list and this is exactly the direction we are going as well, giving women the information they need to make choices. What can we do?
I’ll certainly let you know, Shannon! I definitely think that creating partnerships across birth advocacy organizations is key here.