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New VBAC Guidelines: What they mean to you and your patients

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The American Congress of Obstetricians and Gynecologists. 2010. New VBAC Guidelines: What they mean to you and your patients

Childbirth is a joyous, safe experience for most mothers in the US, and ob-gyns play the leading role in delivering their care. Yet the US lags behind other industrialized nations in healthy births, and we know very little about why. The growing rate of maternal deaths in this country is a significant and deeply troubling problem. The US maternal mortality ratio has doubled in the past 20 years, reversing years of progress. Increasing cesarean deliveries, obesity, increasing maternal age, and changing population demographics each contribute to the trend.

In 2008 the cesarean delivery rate reached another record high—32.3% of all births. There is a community not far from my home in which 45% of the newborns are delivered via an abdominal incision. Let me be very honest. This increase in cesarean delivery rate grieves me because it seems as if we are changing the culture of birth. While it is certainly true that a physician has a contract with an individual patient, our specialty has a covenant with our society.

The College’s new guidelines for VBAC are expected to help address the rising cesarean rate, making trial of labor after cesarean an option for more women. Our Committee on Practice Bulletins-Obstetrics worked tirelessly to review data and evidence, including the 2010 findings of the NIH Consensus Development Conference on Vaginal Birth after Cesarean, to develop our new Practice Bulletin, Vaginal Birth After Previous Cesarean Delivery, described on page six.

Ob-gyns must keep moving ahead to tackle all factors contributing to the maternal mortality rate. While the recently
enacted health care reform law will expand access to prenatal care, research is critically needed to understand how our nation can drive down maternal and infant mortality and prematurity rates. Effective research based on comprehensive data is the key to developing, testing, and implementing evidence-based actions. Other countries have developed robust approaches to maternal mortality and the US should follow their lead.

ACOG’s “Making Obstetrics and Maternity Safer” (MOMS) initiative is a comprehensive, multi-pronged approach to this challenge. The goals of MOMS include understanding and reducing premature births, improving data collection on maternal and infant health, and focusing on obesity research and prevention. ACOG Today will include more on MOMS next month.

We are committed to leading this improvement as part of our imperative to make motherhood as safe as possible. The US Congress and government have important roles to play by helping fund major research to understand and ensure safe births and healthy babies.

I know each of you is committed to making every birth healthy and safe in your practices, and I commend you for the diligent work you do every day.

Disponível em: https://www.acog.org/