ACOG’s Response to the NIH VBAC Meeting

In March, I wrote about the NIH Meeting on VBAC. At the conclusion of that meeting, the panel challenged both ACOG and the ASA (American Society of Anesthesiology) to revise their recommendations that physicians be “immediately available” for VBACs. Since that time, I have been anxiously waiting to see how ACOG would respond to the challenge. In the June edition of Obstetrics and Gynecology (ACOG’s official journal), there are three articles on VBAC and an editorial by the editor-in chief addressing the VBAC crisis. In his editorial, Dr. James Scott calls (not surprisingly) for liability reform and for allowing the patient to make the decision whether to have a VBAC. He also calls for lowering the primary cesarean rate and makes the important point that if we do not reverse our rapidly escalating cesarean rate, that “catastrophic complications from placenta accreta and placenta percreta associated with multiple repeat cesarean soon may be a greater problem than uterine rupture.”

In the same issue of Obstetrics and Gynecology, there is an impressive editorial by the current President of ACOG, Dr. Richard Waldman. Dr. Waldman addresses the need for liability reform; urges increased collaboration with ACNM, calls for measures to reduce racial disparities in maternity care, and recommends far fewer cesareans. He also encourages fellow ACOG members to listen to and to respond to critics who are increasingly frustrated with the increased use of technology and overuse of interventions in maternity care. He reminds doctors that women and families have lifelong memories of birth and may remember “every word, every moment, every nuance of the birth.”

Clearly, now is the time for childbirth educators to work with all the other members of the health care  team – physicians, midwives, nurses, and doulas – to address the problems in maternity care today. Reducing unnecessary cesareans and inductions and empowering women to have the childbirth experience that they want are goals for all of us.

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