Dear Prof Sandall,

 

Thanks for forwarding this.  A quick look at the heavily medically-dominated agenda/program doesn't inspire much hope for an "unbiased" statement - where are the sociologists?  What are your aspirations for the outcomes?

 

bw

Penny

 

 



	-----Original Message----- 

	From: A forum for discussion on midwifery and reproductive health research. on behalf of Sandall, Jane 

	Sent: Wed 25/11/2009 6:42 AM 

	To: [log in to unmask] 

	Cc: 

	Subject: NIH Consensus Development Conference: Vaginal Birth After Cesarean: New Insights

	

	

	 

	

	

	 

	

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Upcoming Event



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March 8-10, 2010  |  Natcher Conference Center

Bethesda, Maryland 



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For most of the 20th century, clinicians believed that once a woman had undergone a cesarean, all of her future pregnancies required delivery by cesarean, as well. In the 1980s, vaginal birth after cesarean (VBAC) also began to be considered a viable option for these women. Since 1996, however, VBAC rates in the United States have consistently declined, while cesarean delivery rates have been steadily rising.



These changing practice patterns may have medical and non-medical causes. Frequently cited concerns about VBAC include the possibility of uterine rupture during labor, infection, and other complications. However, repeat cesarean delivery carries risks for both mother and baby, and may impact future pregnancies. Additionally, some medical centers do not offer the recommended supporting services for a trial of labor after cesarean (e.g., immediate availability of a surgeon who can perform a cesarean delivery, onsite anesthesiologists). Other possible causes include medical-legal concerns, personal preferences of patients and clinicians, insurance policies, and economic considerations.



An improved understanding of the clinical risks and benefits, and how they interact with legal, ethical, and economic forces to shape provider and patient choices about VBAC, may have important implications for health services planning. To advance understanding of these important issues, this conference will assess the available scientific evidence related to the following questions:



*	What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States? 

*	Among women who attempt a trial of labor after prior cesarean, what is the vaginal delivery rate and the factors that influence it? 

*	What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms? 

*	What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms? 

*	What are the non-medical factors that influence the patterns and utilization of trial of labor after prior cesarean? 

*	What are the critical gaps in the evidence for decision-making, and what are the priority investigations needed to address these gaps? 



After weighing the scientific evidence from a systematic literature review, expert presentations, and audience input, an unbiased, independent panel will prepare and present a consensus statement of its collective assessment addressing these questions.



The conference is free and open to the public. Your input is valuable. Please join us!



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