Birthing Beautiful Ideas

Amy Romano and I are currently in the process of collecting and editing all of the fantastic contributions to the NIH VBAC Statement Primer.

As we get closer to publishing the primer on the new Lamaze community site, Giving Birth with Confidence, we’re also starting to think about the sorts of images we’d like to include in this project.

Although Amy and the site administrators at Giving Birth with Confidence do have a good number of stock images related to pregnancy and childbirth at their disposal, we’d like to keep with the grassroots spirit of this project and include some personal photographs in the primer.

And we’d like to receive some of these photos from you!

Do you have pregnancy pictures you’d be willing to share?

Cesarean section pictures?

Pictures of you during labor?

Pictures of you and/or your family with your VBAC baby?

Pictures from the NIH Consensus Development Conference on VBAC?

Pictures of you at an ICAN meeting, a birth rally, or any other pregnancy and childbirth-related event?

If you’d be willing to include any of these photos in the online version of the NIH VBAC Statement Primer (which, to reiterate, will be housed on the Giving Birth with Confidence site), then please send them via email to me at:

koganowski (at) gmail (dot) com

Just to be as clear as possible, these images will be shared on a public site, so please don’t send any photographs that you wish to keep relatively private.

I look forward to hearing from you!

Women making a difference! Jen Kamel (from VBACfacts.com), Desirre Andrews (president of ICAN and contributor to the primer), Gina Crosley-Corcoran (The Feminist Breeder), and yours truly at the NIH Consensus Development Conference on VBAC.

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

The NIH Consensus Development Panel just released the revised draft of its Consensus Statement on Vaginal Birth After Cesarean.  (The final statement will not be released for another six weeks or so.)

After reading the revised draft, and after considering what I perceive to be its flaws–namely, a lack of discussion about VBAmC (or vaginal birth after multiple cesareans) and of the right to informed refusal–I still think that the statement itself represents a major step forward for women who want to and often have to fight to choose how they give birth to their babies.

And that’s because while I’m not sure that the statement will signal a sea change in policies and practices regarding VBAC (although I would certainly welcome such a change), I think that it gives women a powerful tool to use when discussing VBAC with their care providers.  I also think that it gives maternity care providers a powerful charge to re-evaluate their VBAC policies and practices.

Consider, for instance, the following remarks from the statement’s conclusion:

One of our major goals is to support pregnant women with a prior transverse uterine incision to make informed decisions about TOL versus ERCD. We urge clinicians and other maternity care providers to use the responses to the six questions, especially questions 3 and 4, to incorporate an evidence-based approach into the decision-making process. Information, including risk assessment, should be shared with the woman at a level and pace that she can understand. When both TOL and ERCD are medically equivalent options, a shared decision-making process should be adopted and, whenever possible, the woman’s preference should be honored.

We are concerned about the barriers that women face in accessing clinicians and facilities that are able and willing to offer TOL. Given the level of evidence for the requirement for “immediately available” surgical and anesthesia personnel in current guidelines, we recommend that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess this requirement relative to other obstetrical complications of comparable risk, risk stratification, and in light of limited physician and nursing resources. Healthcare organizations, physicians, and other clinicians should consider making public their TOL policy and VBAC rates, as well as their plans for responding to obstetric emergencies. We recommend that hospitals, maternity care providers, healthcare and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to TOL.

Despite the fact that I would still like stronger language regarding the “shared decision-making process” in the first paragraph above, I think that the informed consent-centered language signifies an overall victory for VBAC supporters.  As far as I can tell, this is the first document in recent history that explicitly and strongly encourages care providers to take steps to 1) fully inform women of the relative risks and benefits of VBAC and repeat cesarean, to 2) make their own policies about VBAC and their VBAC rates public, and to 3) work toward eliminating current barriers to VBAC.

The panel cannot force care providers, hospitals, or medicial societies to make these changes, but it is quite clear that they think these changes should be made.  And to have the force of an NIH consensus statement behind those changes seems quite remarkable to me.

Now let’s use that force to our advantage.