Tag Archives: birth choices

In Honor of Cesarean Awareness Month: Introducing The VBAC Education Project

10 Apr

VBAC was deemed a reasonable and safe option to a routine repeat cesarean by the National Institutes of Health decades ago (1981). But, in recent years, misinformation about its safety and lack of clear national practice guidelines have succeeded in virtually eliminating VBACs in many hospitals. Intro.keyThousands of women are being denied medical care for VBAC and given no choice but to “consent” to a repeat operation they do not need or want. Mothers have the legal right to make their own health care decisions, but that right, more often than not, is not upheld. The  upcoming, evidence-based VBAC Education Project, endorsed by the International Childbirth Education Association and the International Cesarean Awareness Network was developed to answer the many questions parents have about VBAC and provide educators and maternity care professionals with the resources they need to support women who want to labor after a prior cesarean. This volunteer collaborative project will be available for download at no cost.

The VBAC Education Project consists of four sections:

  • žDeciding if A VBAC Is Right for You: A Parent’s Guide (slides)
  • žVBAC for Educators: A Teaching Guide
  • ž Resources for VBAC and Physiologic Birth
  • žEducational Handouts for Parents

For Parents

žIf you are a parent whose baby was born by cesarean section, VBAC_HandoutsForParentsthis evidence-based slide presentation (14 modules) provides comprehensive information on vaginal birth after a cesarean (VBAC), a safe option to a routine repeat cesarean. It will also help you to understand why you may have had a cesarean and how you can do things differently this time. The Resources will help expand your knowledge about VBAC and physiologic (normal) birth. The Educational Handouts for Parents will give you the tools you need to make informed decisions and help you to have a safe and satisfying birth.

žFor Educators and Group Leaders

VBAC For Educators: A Teaching Guide is a companion to Deciding if A VBAC Is Right for You. If you teach childbirth classes or lead a support group for women with a prior cesarean the supporting e-book, VBAC for Educators: A Teaching Guide will help you to present the material to your students. It includes background information for each of the 14 modules, sample class outlines, teaching tips, examples of hospital guidelines and informed consent forms for VBAC you can duplicate for your own educational use. VBAC_ForEducatorsFor mothers considering a birth-center or home VBAC the Teaching Guide also explores the relative safety of VBAC outcomes for low-risk women who begin labor on their own compared to outcomes for planned hospital VBACs.

For Maternity Care Professionals

žIf you are a labor and delivery nurse, office nurse, doula, community-based maternal-child health worker or birth activist, this visual guide provides the medical facts you need to understand the VBAC option, the psychological issues related to laboring for a VBAC after an unexpected prior cesarean, and the many ways you can support and empower mothers to make their own best decisions about how they want to give birth this time. The Resources and Educational Handouts for Parents will be useful for you and the mothers and families you work with.

žFor Physicians and Midwives

žIf you are a physician or a midwife, this visual guide can help provide expectant parents with evidence-based information about vaginal birth after a cesarean. It can also help them to clarify some of the issues they are most concerned about.VBAC_Resources Clinicians rarely have the time to provide parents with all the information they may need to make informed decisions for birth after a cesarean. This guide can help begin the prenatal conversations you will have with mothers to help them make an informed choice about how they want to give birth this time.

The VBAC Education Project will soon be available for free download from www.vbac.com and the International Childbirth Education Association. We hope it will help parents to find out more about the VBAC option and encourage maternity care professionals to safely support them.

Updated June 24, 2015.

Turning a Breech is a Safe Option for Women with a Prior Cesarean

5 Mar

Breech presentation occurs in 3-4% of all term pregnancies and is the third most common reason for performing a cesarean in the U.S. More than 90% of breech babies are delivered by planned cesarean section. External Cephalic Version (ECV), a procedure that helps to turn a fetus from a breech presentation to a cephalic presentation has been shown to decrease the incidence of breech presentation at term for women without a cesarean scar thereby reducing the need for a cesarean section.  However, a study published in the January 2014 issue of  the British Journal of Obstetrics and Gynaecology   suggests it is safe for women with a prior cesarean to have an external cephalic version (ECV) in a medical center. This allows women to labor for a VBAC and reduce exposure to complications from a repeat cesarean.

The researchers in Spain compared a group of 70 low risk women with a prior cesarean with 387 low risk women with a prior vaginal birth who had an external version at or after 37 weeks of gestation.  happy mother with newborn babyAll women were expecting one baby. Physicians were successful in turning a breech in 67.1% of women with a cesarean scar and 66.1% of women with a prior vaginal birth. There were no complications in the group of women with a prior cesarean. Of the women with a prior cesarean 52.8% had a vaginal birth (VBAC). More than half of the women avoided a repeat cesarean section. Of the group of women without a prior cesarean 79.4% had a vaginal birth.

The authors of the study concluded that in addition to the 270 documented cases of uncomplicated ECVs for women with a prior cesarean, their data on 70 additional women that underwent the procedure without a uterine rupture or fetal mortality indicates that ECV is a safe option for women with a prior cesarean who want to labor for a VBAC.

Concern from the medical community for the complications of cesarean section and its impact on mothers and babies is mounting. Recently the American College of Obstetricians and Gynecologists and the Society For Maternal-Fetal Medicine issued Obstetric Care Consensus Statement: Safe Prevention of the Primary Cesarean Delivery which called for physician restraint in performing cesarean sections. The guidelines offered safe directives for preventing the first cesarean including offering a breech version to women to reduce the odds for a cesarean section.

This study on the safety of external cephalic version for women with a prior cesarean adds to the existing evidence and may encourage clinicians to also offer the procedure to women with a prior cesarean who may want to labor for a VBAC.

Resources for Mothers

American Academy of Family Physicians

What Can I Do If My Baby is Breech?

Royal College of Obstetricians and Gynaecologists, U.K.,

Turning A Breech Baby In The Womb

Updated April 25, 2015


New Jersey Poised to Increase Access to VBAC

6 Jan

New Jersey has one of the highest cesarean rates in the country. According to U.S. Preliminary data for 2012 New Jersey has the third highest cesarean rate in the nation,  38.7% preceded by Florida (38.1%) and Louisiana (40.2%). In the last two decades repeat cesarean births without labor more than doubled in New Jersey, from 40% to 85%. According to the New Jersey Department of Health currently one in four cesareans are routine repeat operations without serious risk indications. The New Jersey VBAC Task Force wants to change that.

Task Force members agree that VBAC should be available to all low-risk women who choose to labor after a prior cesarean and increasing access to VBAC would improve obstetric care. New Jersey hospital VBAC rates vary widely, from 31.0% at Monmouth Medical Center to 0% for Memorial Hospital and Southern Ocean Medical Center in 2011. The Task Force suggested establishing a network of regional VBAC referral centers who can meet safety requirements for VBAC. The Task Force is a multidisciplinary collaborative group which includes the New Jersey Hospital Association, health insurance payers and malpractice insurers.  20111225_Jess_6619_2000

Hospitals often deny VBAC care by referring to the costly and realistically unattainable ACOG guidelines which recommend a surgical team and anesthesia be “immediately available” when women labor for a VBAC. Having had a prior cesarean adds a level of risk to the subsequent laboring process, however, the risks of laboring for a VBAC are the same as for women giving birth for the first time, yet women giving birth for the first time are not denied medical care, nor are they told that they are at risk because the hospital cannot guarantee that a surgical team and anesthesia will be “immediately” available in case they would need a cesarean section.

The New Jersey VBAC Task Force concluded that ACOG’s definition of “immediate access” has never been defined by ACOG or any other authority and the legal liability of this ambiguous recommendation is “not conducive to frank discussion with patients, resulting in obscure and often misleading counseling.”

Providing safe medical care for women in New Jersey who want to plan a VBAC is not an impossible task. After more than one year of deliberations, the Task Force concluded that many of New Jersey’s hospitals already have the resources that can meet the safety standards recommended to support mothers who want to plan a VBAC. The Hospital Capacity and Regional Accessibility Subcommittee reasoned that being able to provide advanced neonatal care was just as critical for responding to complications that may develop during labor for a VBAC.

New Jersey licenses 20 hospitals as intensive perinatal centers or intermediate/regional perinatal centers. These hospitals are required to have full-time on-site coverage by neonatal and pediatric specialists and consulting arrangements with anesthesiology. Responding to a Task Force survey, 14 of 20  intensive care perinatal centers  reported having 24-hour in-house obstetric coverage for cesarean, availability of anesthesia and operating room teams, and 60% of the intermediate and basic perinatal centers reported 24-hour on-site coverage and the rest the availability of an off-site obstetrician within 30 minutes once the need for a cesarean was established.

Also in response to the Task Force survey, 7 of the intensive perinatal care centers and 6 of the intermediate care centers were in favor of becoming a regional VBAC referral center.

To successfully increase access to VBAC the Task Force made several recommendations:

  • Re-evaluate the risks of laboring for a VBAC by comparing low-risk women with a prior cesarean with New Jersey’s benchmark population, low-risk multiparous women without a previous cesarean for a more realistic evaluation of potential maternal and neonatal complications.
  • Develop a VBAC education program to educate expectant parents about the benefits and risks of laboring after a prior cesarean.
  • Educate providers and hospitals about the benefits and risks of VBAC, adequate staffing and resources, labor progress patterns for VBAC , guidelines for augmentation of labor, signs and symptoms of uterine rupture or dehiscence and practice drills for appropriate response for a uterine rupture.
  • Educate in-hospital staff about VBAC including, risk management, nursing, anesthesiology, neonatology, lab and blood banks to have a more coordinated response in case of complications.
  • Providers should try to shift the focus of their conversation with their patients from “defensive communication and liability strategies toward true shared decision making.”

Tom Westover, MD of Cooper University Hospital in New Jersey and a member of the New Jersey VBAC Task Force will address health professionals and birth advocates about increasing access to VBAC on March 26 at the New Jersey BirthNetwork Symposium at Rutgers University Inn & Conference Center, Supporting NJ’s Birth Plan: Taking the Next Step and Implementing Evidence-Based, Mother-Friendly Maternity Practices in New Jersey.


Northern New England Perinatal Quality Improvement Network,  VBAC Project

Childbirth Connection, Maternity Care and Liability: Pressing Problems, Substantive Solutions

The Power To Push Campaign Has It Right When It Comes To VBAC

5 Oct

The Power to Push Campain was created in 2010 by the British Columbia Women’s Hospital and Health Center to  reduce cesarean rates and help women make informed decisions about VBAC, elective primary or repeat cesareans.

Based on the latest evidence and respect for women’s ability to make their own decisions about how best to give birth, the Power To Push project has developed  well balanced, easy to understand consumer education booklets that tell it like it is. Resources in five different languages include brochures on VBAC, vaginal breech birth, and ECV, external cephalic version, a safe method of turning a breech around the 37th week of pregnancy. Their website also includes videos featuring real women sharing their personal birth stories and wisdom. Theresa’s VBAC story is honest, encouraging, and unusual given that her OB encouraged her to consider a VBAC. Women can also take the Birthing Misconception Quiz to increase their knowledge about cesarean and VBAC.

At the hospital’s Best Birth Clinic, women can be referred to the Choices in Childbirth Counselling Service where women can meet with a Registered Clinical Counsellor to discuss their concerns, and receive current, evidence-based information on the risks and benefits of cesarean birth.

Everyone involved in the Power To Push Campaign is committed to supporting women’s choices and helping them have the best birth possible. The U.S. can certainly benefit from this exemplary model of care aimed at reducing cesareans and increasing access to VBAC.