Yesterday I came across still another story in the news about a pregnant woman who had to travel hundreds of miles in order to have a VBAC. This was the woman’s fourth pregnancy – her first birth was a vaginal one; her second, a cesarean surgery; and her third a successful VBAC. She was an ideal candidate for a VBAC (and did go on to have a successful VBAC). What is particularly frustrating about this woman’s story is the assertion of the spokesman for Banner Health who said that her local hospital is capable of providing emergency cesarean surgery, but not willing to offer VBACs. Huh? The article says that VBAC services differ significantly from other emergency services, as ACOG guidelines recommend two physicians to be immediately available during the entire period of labor, which can be 24 hours or more. However, this is what ACOG actually says:

“Because uterine rupture may be catastrophic VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”

I interpret ACOG’s statement to mean that a hospital that offers VBAC services should be able to respond immediately to any obstetric emergency. (But not that the hospital is held to higher standards for VBACS.)

When candidates for VBAC are selected according to recommended criteria, research studies consistently support the safety of VBAC. Thank goodness, leading experts and researchers from around the country will be meeting March 8-10 in Bethesda, Maryland to develop consensus guidelines for VBAC. This National Institutes for Health-sponsored meeting is free and open to the public. You can register to attend the meeting or to watch the proceedings via the Web. You can also request a free copy of the final conference statement (and recommendations). Think about taking the time to attend or to watch via the Web this important meeting. The recommendations from this meeting have the potential to substantially bring down the soaring cesarean rate and to provide women who have had cesarean surgery with choice regarding their future births.

I may be a little late in responding to this news story. My husband and I just returned from a fabulous trip to Egypt and Jordan. But I can’t stop thinking about this report from California Watch, a project of the Center for Investigative Reporting. According to an unreleased report from the California Department of Public Health, California’s maternal mortality rate has nearly TRIPLED during the past decade. In 2006, 95 California women died from causes directly attributable to their pregnancies. If California had met the goal set by U.S. Department of Health and Human Services, this number would have been no more than 28. According to the principal investigator for the report, Dr. Elliot Main, the rise in maternal mortality cannot be fully explained by population changes such as fertility treatments, obesity, and older mothers. “What I call the usual suspects are certainly there,” Main said, adding, “However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase.”  Main said that scientists have started to ask what doctors are doing differently. And he added, it’s hard to ignore the fact that C-sections have increased 50% in the same decade that maternal mortality increased.

The increase in maternal mortality is most likely not limited to the state of California. On January 26th of this year, the Joint Commission issued a Sentinel Event Alert on preventing deaths during and after pregnancy. The Joint Commission cautions that pre-existing medical conditions such as high blood pressure, diabetes, and morbid obesity; as well as complications from cesarean surgery, increase the risk of death for pregnant women.

Although it is challenging to reduce the incidence of medical complications such as high blood pressure and morbid obesity, the childbirth educator can influence the cesarean rate of students attending her classes. A research study done at St. John’s Mercy Medical Center in St. Louis, MO (see blog post from October 7, 2009, If a Woman Chooses To Be Induced…) confirmed that, by presenting full information about the risks of labor induction, educators can reduce the percentage of women in their classes who request or agree to elective induction. We know that induction doubles the risk for cesarean surgery for first-time mothers. Childbirth educators can promote cesarean-reducing strategies such as planning for continuous labor support from a doula or other trained labor support person; upright positions and movements for labor (which shorten labor according to a 2009 Cochrane Review); and nonpharmacologic pain management strategies (which allow for intermittent monitoring and which do not activate a cascade of interventions.) Although cesarean surgery is safer than ever before, there is no question that it does increase the risk for death for pregnant women. Reversing the current record-high cesarean rates is a matter of life and death.

I am a week late in “starting” the New Year as my husband and I added an extra week to our holidays in order to attend the BCS national championship game. The Longhorns came close to pulling off a miracle comeback, but it was not to be. Now I can turn my attention to 2010. I am cautiously optimistic about birth in 2010 for the following reasons:

First, I am looking forward to attending the 2010 Mother-Friendly Childbirth Forum and Annual Meeting scheduled for February 26-27 in Austin, Texas. For those of you unfamiliar with the Coalition for Improving Maternity Services (CIMS), CIMS is a coalition of birth organizations including AWHONN, ICEA, Lamaze International, and many, many more. Featured speakers for the February meeting include Ricki Lake and Penny Simkin. For more information about CIMS and the 2010 Mother-Friendly Childbirth Forum, visit the CIMS website at www.motherfriendly.org.

Second, I am planning to watch on the Internet the NIH Consensus Development Conference on Vaginal Birth After Cesarean scheduled for March 8-10, 2010. Unlike the 2006 NIH State-of-the-Science Conference on Cesarean Delivery on Maternal Request, the goal of the VBAC conference is to explore the issues surrounding VBAC so that an independent panel can prepare and deliver a consensus statement on VBAC. I can’t help but believe that the evidence will support increasing access to VBAC. For more information on the conference, visit consensus.nih.gov.

Third, I am eager to see the impact of the new Joint Commission perinatal quality measures which go into effect in April. Childbirth educators should be instrumental in helping hospitals to develop policies and strategies to help decrease elective deliveries before 39 weeks; to decrease cesarean deliveries for low-risk women; and to increase the percentage of women exclusively breastfeeding upon hospital discharge. For more information about the new perinatal quality measures, visit the Joint Commission website.

And finally, 2010 will bring us the first joint Lamaze International-ICEA conference scheduled for September 30-October 3 in Milwaukee. Both organizations are coming together to celebrate their 50th anniversaries and to unite for the future of birth. For more information, visit www.futureofbirthconference.org.

I hope you are off to a good start in 2010. Visit our blog frequently for reports on the meetings above, book reviews, teaching strategies, and news about birth and breastfeeding. Happy New Year!