July 22nd, 2010
BREAKING NEWS: ACOG Admits What We Already Knew
In a long overdue press release, the American Congress of Obstetrics and Gynecologists finally steps forward to revise the old guidelines that had once caused so many hospitals and doctors to “ban” VBAC. In a revision released today, The ACOG now states,
“a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans…”
Hallelujah! It’s about time!
But they didn’t come to this decision on their own. Back in March, the National Institutes of Health held a conference on Vaginal Birth After Cesarean – a conference that I attended, wrote about, and was even featured in during the “Mother’s Stories.” I was so proud to see that at that conference, birth activists from all walks of life – doctors, researchers, midwives, and mothers – gathered to help try to convince the panel to see what we’ve all been seeing, which is that women’s rights are being trampled on when they are denied the safe option of vaginal birth. The ACOG President himself sat in a theatre listening to stories of doctors who couldn’t help their patients because their hands were tied. They heard stories from mothers who had to battle hospitals for the right to birth vaginally, or instead birthed unassisted at home because they could not find a provider able to help them. And they listened to highly respected doctors and researchers present the latest available evidence, which is that VBAC is a safe option, and in fact, it is a safer option than a repeat cesarean for most women.
They were also shown a slide listing grassroots organizations and activists who tirelessly battle to preserve patient autonomy and protect the rights of childbearing women. Thanks to those women who stood up and demanded that this was a human right’s issue, the ACOG also included this in their statement:
“restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC.”
Do they know how long we’ve waited to hear those words?
I know many of us don’t care what the ACOG says, and we’d be VBAC’ing whether they got on board or not. But this statement could actually change maternity care in this country. They have now admitted that women are being “forced” into surgeries they do not want or need. They now admit that cesareans have risks, and that the risks of vaginal birth are much lower than previously implied. They are now admitting that despite their claim as the authority on All Things Obstetric, it took a government panel to investigate this issue for the Truth about VBAC to be exposed.
And I don’t think they get the credit here. I think we do. That’s right – you and me. So thank you to the the women like Joy Szabo, and Jill from Unnecesarean. To the women like Desirre Andrews, and Jennifer Block. To Nicette Jukelevics and Jen from VBACFacts.com. To the women of ICAN, and the midwives who risk prosecution to attend a home birth after cesarean where the state doesn’t support it. To all the women who Tweeted, and Facebooked, and Blogged this issue until government health experts couldn’t help but take notice.
We did this. We made this change happen because we spoke up and insisted on being treated better. But the work is not done yet. Now, we must take this statement to our providers and hospitals and challenge those VBAC “Bans.” Send the statement to your sisters, coworkers, and friends who may be considering a VBAC. Write about it, talk about it, and keep spreading the message until VBAC is no longer a four letter word.
Change is coming. I can see it in the horizon.
Click to Leave a Comment
Woohoo!
I think you have played a big role. You have been fighting this fight well and long, and you deserve credit alongside everyone else you named. Way to go, Gina!
Amber´s last blog ..Silver Bullet
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Yes, you *did* have a great big hand in our continuous voice. Thank you… and thanks to ALL the women who suffered unneeded cesareans along the way; may their pain help avert others’ suffering.
I have a client right now, wanting a VBA2C. She’s going to a local HMO who refused her a TOLAC. We’re strategizing to present this to them and force their hand at letting (barf) her have her baby vaginally. Unknown to them, we’re planning a homebirth, but she still wants to rock their giant HMO boat with her case. I’m proud to walk along beside her.
I’ll be sure to let you know how it goes.
Navelgazing Midwife´s last blog ..Did ACOG finally! Take Their Meds
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Big pat on the back to you!!! I remember sitting in an exam room with an OB resident who spouted off about ACOG guidelines that restricted vbacs for moms like me with 2 previous sections and no vaginal births. I told him “those are just GUIDELINES, I still have a brain with which to decipher the relevancy to my own situation”. I really hope that the same doc will as enthusiastically quote these new guidelines!
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I hope there is some change in practice……
I want to be excited….but a little afraid.
Naomi´s last blog ..Forcing the Hermit out of Mom
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I’m so glad to see this! I’m spreading the word amongst my friends and family that they shouldn’t give up too easily if they want a vbac – even ACOG is supportive of them exploring the options.
Carrie´s last blog ..NTDI- episode 6 – the price of being stink-free
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Yay! I think that you are right, so many women bloggers and organizations like ICAN and midwives and women who fought for their births deserve a big high five! Yay!
Sheridan´s last blog ..I think I hear Angels Singing – ACOG supports VBA2C!
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Did you see the article in the new york time today??
http://www.nytimes.com/2010/07/22/health/22birth.html?_r=1
about the same thing, but was just wondering. My mom called me on the phone to tell me about it. =)
mommymichael´s last blog ..Another Nursing Is Normal post…
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If ACOG wants to commit itself to evidence-based practice it is only logical that they have finally revised (again) their VBAC guidelines to match current evidence. Will this trickle down and effect the way an average OB is practicing, especially in a non-tertiary hospital? I am not convined it will happen any time soon.
I agree, it is birthing women who are currently, and need continue, leading the movement toward women-centered, normal birth in hospitals. History has demonstrated that left to their own initiative, the docs and administrators will only budge so far from their comfort zone.
erin ellis´s last blog ..Birth Belongs to Women- Babies- and Families
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I’m glad that you guys are all glad that ACOG said something that is finally deemed important. I am sorry to say that the boat has been missed as to why the VBAC rate has gone own in the last decade. It is not that physicians need ACOG to tell them it is ok to do a VBAC. We know that in most cases it is fine to do a VBAC. There are 2 simple reasons that VBACs are not as commonly performed by physicians.
1). Liability. While there may been hundreds and thousands of VBACs it only takes one bad outcome to literally end a life and a career in one swoop. I’m not saying this is right or wrong it is just fact. This may not be something easily understood if you are not the one writing the check, but it is prevalent and it is a dominating thought in the field and with malpractice carriers.
2). The one thing that ACOG did not amend is their requirement that an OB, anesthesiologist, and operative team need to be “readily available” when there is a woman in L&D in labor and VBACing. This means that if a woman 1 cm dilated with spontaneous rupture of membranes that the OB and Anesthesia needs to be in the hospital and the hospital (even in a small community) must have an OR in the hospital. As we all know, this labor could be 20-30 hours and this is unfortunate that they have placed this ill-spoken mandate into words. This statement effectively pushed VBAC into the dark ages.
Like you, most physicians see ACOG as a group of old men and women that really are out of touch with the person delivering babies. They do not represent the general population of OB GYN and they literally will not back us in a court of law. They are the academics not the practitioners. This is not to demean any of the work that you all do in order to pursue what you feel is the proper care for pregnant women, it’s just a fact that ACOG has become a lame duck with the general practicing community. It is not ACOG that dictates practice it is the lawyer, which you should understand more than anyone. As stated above residents quote ACOG guidelines because they are surrounded by academics and as stated they are simply “guidelines”.
While I hope the cesarean rate declines because of this I really doubt that we will see much of a drop because no one was waiting for them to say it was ok.
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Hey Gina, thanks for the link and the kudos! Can’t wait to see how this all plays out. I wonder how many VBAC bans will be reversed in the next three to six months….
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Oh how I wish I could have been strong enough to demand a VBA2C. Now I can just work to make sure that other women realize that VBAC is a safe, normal, healthy option. I definitely had some thinking I was crazy going for my first VBAC. And I would have gone for a second too… but it is what it is. Hooray for all of you who have worked so hard to change attitudes regarding birth!
Brenna´s last blog ..Wordless Wednesday- My little butterfly is turning two…
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You’ve probably already seen it, but you were quoted in this article:
http://www.rhrealitycheck.org/blog/2010/07/21/birthing-oldfashioned-acog-says-vbacs
Way to go!
Alyssa @ St. Louis Smart Mama´s last blog ..Alfie Kohn Takes On the Myth of the Spoiled Child
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Hear, hear!!!
Sarah DeGroff´s last blog ..Doula-ing my nephews gorgeous home waterbirth!
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I think this is a step in a good direction, but I am not getting excited yet.
Good Doctor – None of that is news to most of the folks who have tried to have a VBAC, or have had a section already. I was told flat out, “I won’t help you, b/c I don’t want to sit in the hospital with you while you labor.” I asked why…he’d be getting paid to sit there! “I think my time is worth more than that.” That doctor didn’t need to show me the door…I was on my way out as he finished his sentence.
I WANTED to VBAC in a hospital, b/c I thought it would be the safest thing to do! According to the idiots running my state & putting medical laws into place, they thought if they banned enough VBACs from hospitals all us uneducated housewives would roll over & re-sect. Well…we went into the homes instead…and that REALLY pissed them off…b/c now…we can’t even do THAT with help. Our option currently is to do it unassisted. Yeah…that seems MUCH safer than being a few feet away from an operating theater. 
Maegan´s last blog ..A Day to Remember
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Thank you SO much for your posts.. They really are truly inspirational. I had a friend of mine who recently underwent a successful VBAC and pointed me in the direction of your page.
I had an “emergency” c-section with my daughter. She was not in distress, neither was I.. but apparently the doctor got impatient with my progress (I reached a 9 1/2 and they had me start pushing… my cervix swelled because of this and my 8lb 11.5oz daughter could not fit through). They had also given me pitocin to speed things up… which I feel doomed me from the beginning.
I’m 19 weeks pregnant with my 2nd child and am seriously considering a VBAC. Unfortunately, the hospital here in town has banned VBACs, so the drive for us will be an hour and a half to a hospital that actually does them. This is kind of scary for me…but I’m SO SICK of being told that I HAVE to have a 2nd c-section because I had one before.
My husband is not happy with this consideration.. Merely because he’s been pumped with the same falsities that everyone else has.. that VBACs are dangerous because of the danger of the uterus rupturing. I keep trying to prove to him that a 2nd c-section is actually more risky.. we’ll see where it goes.
Thank you again! I’m loving it!
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There may be info on the ican.org website that might help with explaining to “family members” about how this is okay! I know I saw it somewhere…maybe that’s not the right place….but google!! Good luck momma.
Maegan´s last blog ..A Day to Remember
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Thank you so much for including my book, Understanding the Dangers of Cesarean Birth: Making Informed Decisions, as one of the many birth advocates’ efforts to reduce cesareans. I’ve been a childbirth educator for 30 years and had many physicians refer pregnant moms to my VBAC classes in the eighties and early nineties. It was unbelievable to see the pendulum swing after the 1999 ACOG guidelines recommended an emergency cesarean be “immediately available” as opposed to “readily available” when women labored for a VBAC as it had been since their first VBAC guidelines came out in the early eighties.
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