A Woman's Guide to VBAC

In June 2010, a National Institutes of Health (NIH) panel published a Consensus Development Conference Statement on vaginal birth after cesarean (VBAC).

In addition to examining the current evidence related to VBAC and offering recommendations for future research on this topic, the NIH panel concluded that VBAC was a "reasonable option" for most women with a previous cesarean section.

In the context of a current birth climate that can be somewhat hostile toward VBAC, this was an exciting moment for many birth advocates, maternity care providers, and mothers!

But even with all that is included in the NIH Statement on VBAC, it might be difficult for many of us to wade through the information in it and figure out what it means for us and our particular birth options and unique circumstances.

This is where the Guide comes into play.

A group of maternity care experts and VBAC advocates came together to create A Woman's Guide to VBAC: Navigating the NIH Consensus Recommendations, a free online resource guide that addresses the most common and pressing questions women may have about their birth choices in what could be called the "post-NIH-Consensus-Recommendations Era." We hope the Guide gives you the tools you need to empower yourself to advocate for you, your baby, and your birth choices!

Sections in A Woman's Guide to VBAC:

• Weighing the Pros and Cons of Planned Vaginal Birth after Cesarean and Repeat Cesarean Section
• VBAC Success Rates and Prediction Models: Understanding Your Chances of Important Outcomes
• Putting Uterine Rupture into Perspective
• Are You an "Ideal" Candidate for VBAC? What Are Your Choices If Not?
• The "Immediately Available" Standard: Where It Came from, What It Means, and How to Move Forward with New Evidence and Guidelines
• What We Don't Know: Critical Gaps in Evidence and How to Make Informed Choices In Spite of Them
• Discussing Your Options with Your Care Provider
• Legal Rights and Protections for VBAC: Issues from the NIH Consensus Conference
• Take Action!
• VBAC FAQ

The Inspiration for this Project

The concept for this guide was borne out of many things: the timeliness of the NIH panel's statement on VBAC, the importance of the statement itself, and our personal interest in advocating for women seeking vaginal birth after cesarean.

But we would be remiss if we didn't acknowledge another source of my inspiration for this project: namely, the heartfelt and heartening consumer participation in the NIH Consensus Development Conference on Vaginal Birth After Cesarean.

As women who were lucky enough to attend the NIH Consensus Conference on VBAC in person (Kristen) or view the entire proceedings in real time by webcast (Amy), we can say with some certainty that consumers !! that is, the mothers, doulas, midwives, nurses, doctors, and other birth advocates who traveled from near and far and volunteered their time to attend:played a big role in this conference!

We listened, we read, we talked with one another, we got the word out to women who couldn't participate in the meeting, and we asked some of the most incisive questions of the entire conference proceedings.

Quite simply, we made a difference.

This guide is dedicated to those consumers:and to all of us who are maternity care consumers, whether we are currently pregnant, have been pregnant, or simply work and advocate on behalf of pregnant women..

What exactly is a National Institutes of Health Consensus Development Statement? This statement is the product of an NIH Consensus Development Conference. These two-and-a-half day conferences:which are free and open to the public:are organized by the NIH to address issues in medicine that are both controversial and pertinent to health care providers and the general public. During the NIH Consensus Development Conference on VBAC, an independent panel listened to presentations given by invited expert speakers. The panel also heard input from members of the general public during Q&A sessions. Finally, drawing upon the conference proceedings and upon a systematic review of the evidence on VBAC, the panel drafted their statement on VBAC.

Like all Consensus Development Statements, the statement on VBAC is not legally binding. It does not create practice guidelines, nor does it establish any health policies. Nonetheless, it is still an exceedingly important document. In fact, because of the high-quality evidence that the NIH panel uses to create consensus development statements, the NIH claims that it is "reasonable to expect that the panel will be able to give clinical guidance" to care providers.