WHAT ’ S KICKI N’ ? News you won’t get anywhere else
NIH says remove barriers to VBAC
In March 2010, the National Institutes of Health (NIH) held a Consensus Development Conference, “Vaginal Birth After Cesare- an: New Insights,” to examine the rates, patterns, and use of vaginal birth after cesarean (VBAC) and trial of labor (TOL), and the benefi ts and risks of TOL vs. elective repeat cesarean delivery (ERCD).
Some 31 percent of US births are by cesarean section. Of
the 1.3 million C-sections performed each year, 40 percent are repeat C-sections. According to the NIH conference program, “NIH Consensus Development Conference—Vaginal Birth After Cesarean: New Insights, Program and Abstracts,” the rate of VBACs in the US rose from 3 percent in 1981—when the NIH recommend- ed a decrease in the overall national C-section rate, as well as an increase in the use of VBAC—to a high of 28.3 percent in 1996. The program states that the decline in VBACs appears to have begun in 1997, after the publication of a New England Journal of Medicine article, by McMahon et al., titled “Comparison of a Trial of Labor with an Elective Second Cesarean Section” (September 1996). The VBAC rate declined more dramatically after 1999, when
the American College of Obstetricians and Gynecologists (ACOG) changed its recommendation; instead of “encouraging” VBAC, ACOG said women should be “off ered” VBAC in settings capable of handling emergencies, and if a physician able to perform a C-
section is “immediately available.” Although 60 to 80 percent of
VBACs are successful, the VBAC rate fell to 8.5 percent in 2006. The Draft Statement of the March NIH conference concludes
that “TOL is a reasonable option for many pregnant women with a prior low transverse uterine incision.” The statement says that one of NIH’s major goals is to support these women in
making informed decisions about TOL vs. ERCD. The Draft
Statement recommends that ACOG and the American Society of Anesthesiologists “reassess” their requirement for “immediately available” surgical and anesthesia personnel in hospitals, and
vaccines
Parents worried about
36 mothering | May–June 2010
that maternity-care providers, consumers, policymakers, and health-care and professional-liability insurers work together to develop services that reduce or eliminate barriers to TOL. Read the full statement at
http://consensus.nih.gov/2010/
vbacstatement.htm.
—Jessica Haney
The debate over vaccine safety is not going away.
According to a recent Pediatrics study, a majority of parents are concerned about serious adverse events related to vaccines. In January 2009, 2,521 online surveys were sent
to a nationally representative sample of parents of children under 17; the response rate was 62 percent. Ninety percent of respondents agreed with the statement “Getting vaccines is a good way to pro- tect my children from disease.” However, 54 percent
agreed with the statement “I am concerned about
serious adverse eff ects of vaccines,” and 25
percent agreed with “Some vaccines cause autism in healthy children.” Eleven-and-a-half percent of parents who responded had refused at least one vaccine recommended by their doctor. One of the study’s conclusions is that if concerns about the safety of vaccines are not adequately ad-
dressed, the current high rates of childhood vaccina- tion may not continue. The study, “Parental Vaccine
Safety Concerns in 2009,” by Freed et al., was published by Pediatrics online on March 1, 2010.
ISTOCK PHOTO
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