International Cesarean Awareness Network

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2018 Cesarean Awareness Month T-Shirt Design Contest!

January 2, 2018 by blog

During Cesarean Awareness Month in April every year, we sell a t-shirt to bring in funds for our mission and to spread awareness through people wearing these t-shirts far and wide. This year we’ll be choosing our CAM shirt design from submissions from people like you!

Beginning now, we will accept submissions of t-shirt designs via email to Board@ICAN-online.org until January 31st, 2018. We will choose the designs to be voted on. The winner will receive a free t-shirt!

Musts:
-Your design should be relevant to ICAN’s mission
-Must be a high-resolution image in png, tiff, or pdf
-Designate if you intend the image to be the front or back of the shirt
-Keep your design working file saved in case small tweaks are needed
-The work must be your own – no copyrighted images or aspects allowed

Tips:
-ICAN’s official colorway is Hex #820024 (but it isn’t required to use only that color)
-Simpler tends to read better on a shirt.
-The number of colors used can impact whether an idea works as a shirt design.
-Be mindful of wording. (There is no easy guide for this, and it is not possible to perfectly resonate with everyone’s own perspective, but just thinking about how any given phrase may come across to the public is helpful.)
-Submission of your artwork gives ICAN the rights to use the image as our own to further serve our mission.

Have FUN! We are very excited to see your creativity at work!

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Filed Under: Cesarean, Education, ICAN Tags: Cesarean, Education, Media

Of Evolution, Culture, and the Obstetrical Dilemma

December 11, 2017 by blog

This story originally appeared at Undark Magazine.

By Josie Glausiusz, November 29, 2017


HARVEY KARP, THE BESTSELLING author of the “The Happiest Baby on the Block,” has some advice on his website for frazzled new parents: “Remember — your baby’s brain was so big that you had to ‘evict’ her after 9 months, even though she was still smushy, mushy and very immature.”

It’s not an idea unique to Karp. Scientists have long struggled to explain the myriad challenges attending human childbirth compared to other primates, from the relative helplessness of human infants to the very “tight fit,” as some researchers have put it, between the female human pelvis and the typical size of a child that must pass through it.

The mystery was the catalyst for what became known as “the obstetrical dilemma,” a long-debated though widely accepted hypothesis suggesting that the upright gait of Homo sapiens was accompanied by a narrowing of the pelvis — an evolutionary tradeoff that resulted in increased risks to pregnant mothers as they struggled to push large-brained babies through ever-slimmer birth canals. Among other things, the dilemma has been used to suggest that the wider, birth-giving hips of women have hindered them locomotively and athletically — and perhaps even evolutionarily — compared to men.

That has always struck some scientists as too pat an explanation, though it is only in the last decade or so that the theory, which still has many subscribers, has received substantive pushback. Today, challenges abound for the idiosyncrasies of human gestation and birth — including new notions that look beyond evolution to more proximate and modern factors like poor diet and obesity.

Of course, rigorous debate over the relative strengths and weaknesses of theories in this cul-de-sac of physiological science will surely continue. But for all the back-and-forth, one thing seems quite clear: The days of simply describing the human birth process — and women themselves — as evolutionarily compromised seem to be coming to an end.

For some researchers, that change in thinking is long overdue.

SHERWOOD WASHBURN, THE physical anthropologist who coined the phrase “obstetrical dilemma,” first published his theory in the September 1960 issue of Scientific American. He argued that “in man, adaptation to bipedal locomotion decreased the size of the bony birth canal at the same time that the exigencies of tool use selected for larger brains. This obstetrical dilemma was solved by the delivery of the fetus at a much earlier stage of development.”

Early delivery, he concluded, foisted far greater responsibility on the “slow-moving mother,” who was now forced to hold her “helpless, immature infant,” while the men went out hunting.

The assumption that “women are compromised bipedally in order to give birth” is widely accepted, says anthropologist Holly Dunsworth of the University of Rhode Island. But Dunsworth sees flaws in this premise. Women already have a range of dimensions in their birth canal, she thought, and they are all walking just fine. Indeed, research on human skeletons by anthropologist Helen Kurki of the University of Victoria in Canada has shown that the size and shape of the human birth canal vary very widely, even more so than the size and shape of their arms.

So in 2007, Dunsworth went looking for evidence to support the obstetrical dilemma as it has traditionally been understood.

“When I couldn’t, I thought I was crazy,” she says. Intrigued, she enlisted Anna Warrener, a professor of biology and biomechanics, then at Harvard University, to test the notion that wider pelvises in women decrease the efficiency of locomotion. After measuring the chain reaction of forces moving through the body — from the foot to the leg to the hip — Warrener and her colleagues found that wider hips do not increase the cost of locomotion. Indeed, both women and men are equally efficient at walking and running, and in hunter-gatherer societies, women walk, on average, 5.5 miles per day, often while caring and feeding infants as well.

“The obstetric dilemma, in its definition, has housed this idea that women aren’t as good as men in some things because they have to give birth,” adds Cara Wall-Scheffler, an evolutionary anthropologist who studies human locomotion at Seattle Pacific University. “I have a number of papers that show that women are great walkers, and in some particular tasks women are better — they don’t use as much energy, they don’t build as much heat, they can carry heavier loads with less of an energetic burden.”

Dunsworth has an alternative theory as to why human pregnancy ends when it does: It’s called EGG, for “energetics of gestation and fetal growth,” and it applies not just to humans but to other mammals too. While a mother’s metabolic rate doubles during pregnancy, the fetus’s energy needs to increase exponentially towards the end of pregnancy. “As the fetus gets bigger and bigger and costlier and costlier to grow inside of the uterus,” Dunsworth explains, the mother’s metabolic rate reaches a limit. But the baby has to continue growing, “so the only way to do that is to get born.”

She is currently testing EGG on pregnant marmosets, measuring their energy use and metabolic rate during pregnancy over time, “to see if they give birth when they reach their maximum sustainable metabolic rate, as we do.”

Still, others seek to explain why human brain volume has tripled over the past 2.5 million years, from the time of the Australopithecines. In a 2016 paper, brain and cognitive sciences researchers Steven Piantadosi and Celeste Kidd of the University of Rochester argue that helpless, larger-brained but early-born babies select for parents with advanced intelligence who must interpret their wordless signals; these larger-brained parents produce babies with ever-increasing brain size, a self-reinforcing process leading to “runaway selection for premature infants and big brains.”

Dunsworth readily acknowledges that childbirth can be difficult, and that the human birth canal is indeed a tight fit for the fetus, even though humans are born with the smallest relative brain of all primates (only 30 percent of our adult brain size, compared to chimps, whose brains at birth are 40 percent of adult size.) Globally, an average of 216 women dies for every 100,000 live births, according to data from UNICEF. But the disparity between high- and low-income countries is gigantic: The lifetime risk of maternal death in rich countries is 1 in 3,300, compared to 1 in 41 in poor countries.

As such, blaming reproductive complications on evolution, writes Pamela K. Stone of the Culture, Brain, and Development Program at Hampshire College in Amherst, Massachusetts “conceals the larger health disparities and risks that women face globally.”

Childbirth is difficult for many reasons, she writes — among them the 19th-century switch from birthing in the upright position, which allows the pelvic girdle to expand in response to contractions, to the supine position (still common among women in the West) which often requires the use of forceps.

ENTER JONATHAN WELLS, a professor of anthropology and pediatric nutrition at the Great Ormond Street Institute of Child Health at University College London who argues for a competing hypothesis on the obstetrical dilemma. For starters, Wells argues, long-term ecological trends have likely played a role in changes in both pelvic dimensions and offspring brain size. One such trend was the rise of agriculture about 11,500 years ago in the Levant, which led to a shift from high-protein diet common among foragers to one replete with cereals. A high-carb diet is associated with both increased birth weight and shorter stature in the mother, and short stature is linked to smaller and flatter pelvises.

By that reasoning, the emergence of agricultural diets could have impacted “maternal mass and brain size, and may, therefore, have exacerbated the obstetric dilemma,” he says.

More recently, Wells has pointed to trends in both malnutrition and obesity as culprits in what he describes as a “new” obstetrical dilemma. According to Wells, this “dual burden” is contributing to a rising toll of obstructed labor, gestational diabetes, and larger-than-average newborns. Wells describes his theory in the April 2017 issue of The Anatomical Record.

Between 1980 and 2013, the percentage of overweight and obese women globally rose from 29.8 percent to 38 percent. At the same time, one in three people is malnourished in one form or another. “There is rapidly accumulating evidence,” Wells says, “that the dual burden of malnutrition can occur within the same individuals: Those who experienced poor nutrition and became stunted in early life, but who have also been exposed to obesogenic pressures from childhood onwards and who have therefore gained excess weight subsequently.”

As Wells notes, obstructed labor, where delivery of the baby causes harm to the mother, child or both, accounts for 12 percent of maternal mortality worldwide. It also increases substantially the risk of serious long-term maternal injuries, such as obstetric fistula. Dunsworth’s EGG theory can’t explain this frequency, he says.

But the combination of obesity and malnutrition can: Malnutrition and infectious disease in childhood are linked to short stature, which is associated with smaller pelvises in adulthood. Obesity, which is rising fastest in populations most prone to childbirth complications, increases the risk of delivering a “macrosomic” baby, whose birth weight exceeds the 90th percentile in any given population. “Overweight women in most populations are more likely to develop gestational diabetes if they are also short,” Wells adds. The combination of gestational diabetes and maternal obesity doubles the risk of macrosomic babies. So in theory, Wells says, a short overweight woman has two different risk factors for obstructed labor: smaller pelvic dimensions, and a higher probability of producing a large newborn.

This scenario is further aggravated by the persistence of child marriage, in which teens give birth before pelvic growth is completed, and gender inequality. A recent study of 31 countries in sub-Saharan Africa conducted by Alissa Koski, a postdoctoral scholar at the UCLA Fielding School of Public Health, found that more than one-third of girls in more than half of the countries studied married before the age of 18. In another study of 96 countries, Wells and his colleagues found “strong associations” between societal gender inequality and the prevalence of low birth weight, stunting, wasting, and child mortality. “On this basis,” he says, “societies with high levels of gender inequality are more likely to produce adult women of smaller body size,” which will impact the dimensions of the pelvis.

At the other extreme, he notes, obesity is increasing in prevalence faster in women than in men. Given these rapid increases in obesity, overweight women are more likely to experience difficulties in delivering babies if they were also stunted in childhood, Wells predicts — although so far, he doesn’t have the data to prove it. It is clear, however, that cesarean delivery has become one of the most common surgical procedures worldwide, increasing to “unprecedented levels” between 1990 and 2014 and ranging from 6 to 27 percent of all births in the least to most developed regions, respectively.

Dunsworth sees this as something of a self-fulfilling prophecy. “I worry that this idea [of the obstetrical dilemma] is justifying status-quo high rates of C-sections and other childbirth interventions,” Dunsworth says. “People say, ‘it’s just evolution — there’s nothing we can do, and here’s how technology helps, and that’s fabulous. But I know we’re overdoing it. Everybody knows that.”

While Dunsworth says she admires Wells’ research, she adds that she wishes he would come out a little more strongly against the evolutionary obstetrical dilemma.

For his part, Wells describes the work of Dunsworth and her colleagues as being of “major importance.” But “that doesn’t mean that Washburn had no important message,” he adds. “We have to acknowledge that the process of birth is surprisingly complex in humans, compared to other apes.”

“It is very clear from maternal mortality statistics that the contemporary burden of the obstetric dilemma is highly unequally distributed amongst women,” Wells says. “This suggests that if we had a better understanding of its biological basis, we could improve our efforts to reduce the burden of maternal and child mortality.”


Josie Glausiusz is a journalist who writes about science and the environment for magazines including Nature, National Geographic, Aeon, and the Israeli newspaper Haaretz. Her Hakai magazine article, Land Divided, Coast United won Amnesty International Canada’s 2015 Online Media Award. She is the author of Buzz: The Intimate Bond Between Humans and Insects. Follow her on Twitter @josiegz.

Undark is a non-profit, editorially independent digital magazine exploring the intersection of science and society. It is published with generous funding from the John S. and James L. Knight Foundation, through its Knight Science Journalism Fellowship Program in Cambridge, Massachusetts.

Filed Under: Cesarean, Education, ICAN Tags: Cesarean, Education, Media

Ding! Ding! The Turkey is Done But is the Baby?

November 15, 2017 by blog Leave a Comment

jez-timms-359124Being pregnant during the holiday season brings a unique component to the time of year that many find full of joyful stress. If your due date falls between early November and early January, that stress can be amped up even further. Will your water break as you pull the turkey from the oven? Will you be able to decorate a tree or light candles with your children or will you be in the hospital laboring? So many questions about the various birth scenarios arise that it might seem like a good idea to schedule an induction to have some small control over birth timing. But is that the best choice for you and your baby when not medically necessary?

Induction of labor frequently increases birth interventions such as fetal monitoring, epidural anesthesia, instrumental delivery, and cesarean section. First-time mothers undergoing induction double their risk of having a cesarean, which increases risks in subsequent pregnancies such as uterine rupture, placenta previa, placenta accreta, and hysterectomy. Though VBACs and induction are compatible in most circumstances, a woman with a prior cesarean has a 33-75% risk of having another cesarean.

If your provider starts a discussion about scheduling an induction right before a holiday, ask questions.

  • Is there a medical reason to start labor?
  • Are there non-medical alternatives to induce labor?
  • Am I or my child in immediate danger if I don’t labor now?
  • Is my body ready for labor? (Ask for a Bishop score)
  • What is the research on induction risks and outcomes?
  • Do I need to make a decision now or can I wait?

Research your options and decide what is best for you and your child. Only a turkey should be on a timer.

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Bishop Score Information

Induction Information

Photography Credits: Jez Timms; Gabriel Garcia Marengo – www.UnSplash.com

Filed Under: Education, ICAN Tags: Education, Induction

Top 11 Ways to Decrease Your Risk for a Cesarean

November 13, 2017 by blog 3 Comments

Guest post by Dr. Poppy Daniels, OB/GYN


  1. Choose a provider/facility with a low cesarean rate – Midwives have lower cesarean rates: the Midwives Model of Care has a more holistic approach to prenatal care, familiarity and patience with longer labors, and the fact that midwives are not surgeons. Many OBs & hospitals have lower than average cesarean rates, information about which can often be found online or by asking directly.
  2. Hire a doula – A doula is a trained labor assistant whose primary purpose is to support the laboring women. This physical & psychological support is critical in helping women to stay encouraged to continue, even in the face of long labors, which is why studies have shown that doulas are associated with lower cesarean rates.
  3. Be active in labor – Utilizing different positions & strategies in labor: standing, walking, swaying, dancing, birth balls, water therapy (whether shower or birth tubs) are more helpful than lying flat on your back on a continuous fetal monitor. Intermittent fetal monitoring or wireless monitors enable women to be more active.
  4. Avoid “soft” reasons for induction – Many reasons that women are induced are not truly evidenced-based & may increase the likelihood of cesarean: presumed macrosomia (“big baby”), mild blood pressure elevation without evidence for pre-eclampsia, being 39 or 40 weeks pregnant, or patient TOP (tired of being pregnant). Women who start inductions with an unfavorable cervix may be more likely to end up with a cesarean.
  5. Prepared childbirth classes – The more education moms and dads have about childbirth, the more likely they will be able to advocate for themselves during the ups and downs of unpredictable labor. Community-based childbirth classes are usually more focused on the physiology of labor & birth than hospital-based classes which can sometimes favor discussions of interventions to expect (IVs, epidurals, cesareans). While epidurals in the active phase of labor do not increase the risk for cesarean, epidurals in the latent phase (now defined as before 6 cm) can.
  6. Stay home as long as possible & ask for more time – Parents, especially first-time ones, can be excited about the latent phase of labor and go in very early in the process, increasing the likelihood of interventions. However, women who break their water & have an unknown station, are GBS positive, have bleeding or significant pain may need to go in sooner rather than later. Simply giving women more time once in the hospital has been shown to reduce the cesarean rate.
  7. Eat before you go in. – Despite mounting evidence that starving pregnant women in labor does more harm than good, many hospitals haven’t changed their policies and still limit moms to liquids & ice chips.  Not getting fuel before a marathon is a bad idea for runners and a bad idea for pregnant women.  Maternal exhaustion and hypocaloric intake can lead to an inefficient/low energy pushing, potentially increasing the risk for cesarean.
  8. Exercise, prenatal chiropractic, massage & acupuncture. – Pregnancy can cause many changes to the musculoskeletal system from lumbar lordosis to sciatica to carpal tunnel syndrome. Regular moderate exercise and other holistic treatments are beneficial to keep women loose, limber and prepared for the physicality of labor.
  9. Choosing a healthy diet and controlling blood pressure/blood sugar – Women with excessive weight gain in pregnancy, hypertension, and gestational diabetes are much more likely to end up with a cesarean delivery.
  10. Avoid listening to bad advice & “birth horror stories” from friends & family – Labor & birth is as much a head game as it is a physical challenge. Surround yourself with positive people who believe in your ability to have an empowered birth rather than naysayers who may mean well but undermine your confidence.
  11. If your baby is breech, consider finding a chiropractor trained in the Webster technique, doing exercises outlined in Gail Tully’s Spinning Babies, or find a physician with experience performing external cephalic version or vaginal breech delivery.  If a cesarean is unavoidable, discuss your desires for VBAC or a larger family with your OB before surgery, if possible.

poppy-daniels

 

Poppy Daniels is an Obstetrician/Gynecologist in private practice in Ozark, MO. You can follow her on Twitter @drpoppyBHRT.

Filed Under: Education, ICAN Tags: Cesarean, Education

ICAN Addresses ACOG Practice Bulletin 184: Vaginal Birth After Cesarean Delivery

November 3, 2017 by blog

announcement

We, the International Cesarean Awareness Network (ICAN), would like to address the recent publication of Practice Bulletin 184 from the American College of Obstetricians and Gynecologists (ACOG), titled: “Vaginal Birth After Cesarean Delivery”. ICAN is a non-profit organization whose mission is to improve maternal-child health by reducing preventable cesareans through education, supporting cesarean recovery, and advocating for vaginal birth after cesarean (VBAC).

ICAN is hopeful that ACOG’s new VBAC guidelines will enable more maternity care consumers to find the support and evidence-based care that they need and deserve. Multiple statements throughout Practice Bulletin 184, such as “Coercion is not acceptable”, and “Global mandates for TOLAC are inappropriate because individual risk factors are not considered”, lead us to believe ACOG is working to decrease the widespread hospital VBAC bans that currently exist in the United States. As ACOG states, “respect for patient autonomy also dictates that even if a center does not offer TOLAC, such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery”. While ACOG also expresses understanding that some facilities may still choose to mandate surgery for patients with a history of prior cesarean(s), they made sure to add that “patients should be allowed to accept increased levels of risk” (eg, make their own choice), and stated that “none of the principles, options or processes outlined here should be used by centers, obstetricians or other obstetric care providers, or insurers to avoid appropriate efforts to provide the recommended resources to make TOLAC available and as safe as possible for those who choose this option”.

While we are encouraged by ACOG’s apparent stance that VBAC bans should not limit a patient’s right to informed consent and informed refusal, we are discouraged that they also chose to continue their hard stance against out-of-hospital VBAC. In their “Summary of Recommendations”, ACOG cited their recommendations regarding out-of-hospital VBAC as stemming from “consensus and expert opinion”, which is “Level C”. Maternity care consumers choose out-of-hospital birth for a variety of reasons.  For example, if a local hospital mandates surgery for all patients with a prior cesarean, some may feel their only option is to birth out-of-hospital. ICAN supports a person’s right to choose their preferred birth location.

We greatly appreciate ACOG’s clarification regarding Level 1 facilities. ACOG, along with the Society for Maternal-Fetal Medicine, described Level 1 facilities as those that “can provide basic care”. They also stated that although there is reason to think rapidly available cesareans can provide “small incremental benefit in safety”, there is no data available to compare “alternate systems and response times”.  We are hopeful that this clarification may effect change among Level 1 hospitals with existing VBAC bans.

Possibly the most unexpected addition to this bulletin is the frequent mention of web-based VBAC calculators. In January of 2017, an article titled: “Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population”, discussed the accuracy of the MFMU web-based VBAC calculator. The MFMU VBAC calculator appears to be the calculator that is most widely used among medical professionals. This study found that when using the MFMU VBAC calculator, predicted rates were “highly accurate” for those patients that received predicted “success” rates over 65%. However, for the patients that received predicted “success” rates of less than 35%, the study found the actual VBAC rates were nearly “twofold higher” than the predicted rate. In addition, ACOG clearly states that “no prediction model for VBAC has been shown to result in improved patient outcomes.”  ACOG points to using individualized care several times in Practice Bulletin 184, but VBAC calculators do not take individual circumstances into consideration. For example, a previous diagnosis of ‘Failure to Progress’ can be attributed to many issues, one of which being simply a failure to wait.  In ACOG’s Obstetric Care Consensus, titled: “Safe Prevention of the Primary Cesarean Delivery”, they stated that “studies that have evaluated the role of maternal characteristics, such as age, weight, and ethnicity, have consistently found these factors do not account fully for the temporal increase in the cesarean delivery rate or its regional variations”.  We feel that by encouraging physicians to use web-based VBAC calculators, we may see a decrease in the rate of TOLAC, and subsequently a decrease in the rate of overall VBAC.  

Multiple criteria are used in the development of web-based VBAC calculators, including maternal age, body mass index, prior vaginal delivery, and race, among others. The paragraph in Practice Bulletin 184 that discusses “obesity”, leaves a final sentence that states patients who have a BMI of “30 or greater may be candidates for TOLAC, depending on their other characteristics (eg, having had a prior vaginal delivery), and their care should be individualized”. If ACOG’s intention was not to limit options for people with a BMI over 30, we question why they chose to include the words “may be candidates” while adding an example of “having had a prior vaginal delivery”. We strongly feel this statement may lead some physicians and midwives to decrease access to TOLAC for those with a BMI over 30, that have not had a prior vaginal birth. According to ACOG, cesarean delivery poses a greater risk of “infection, bleeding, and other complications” for an “obese woman” than for someone with BMI in the normal range.

ICAN as an organization strongly opposes the use of a patient’s race in VBAC calculators. There is a lack of scientific evidence that offers an explanation of why race is included in the calculations. Until peer-reviewed research examining correlations between race and mode of delivery provides something other than results such as “possible physician bias”, or “cross-cultural differences”, race should not be part of the criteria used to estimate the probability of vaginal birth. Race has not been conclusively determined to be a causation versus correlation for higher risk of repeat cesarean, but instead appears to be due to societal issues, including systemic racism in the medical system. Our society is ethnically and racially diverse. We challenge ACOG to develop a culturally informed maternity care response to the rising cesarean rates among all people, but specifically among People of Color.

In December of 2016, ACOG clarified their stance on Vaginal Birth After Two Prior Cesareans (VBA2C), stating: “Most women with two previous low-transverse cesarean deliveries are candidates for and should be offered TOLAC and counseled based on the combination of individual factors that affect their risk and probability of achieving a successful VBAC”. With the amount of available data showing similar rates of attempted TOLAC turned VBAC between those with one prior cesarean, and those with two prior cesareans, and the studies showing similar, to a 1-2% increase in risk of uterine rupture, we are disappointed that Practice Bulletin 184 did not reflect the 2016 clarification wordage.

For maternity care consumers with Special Scars (classical, prior rupture, j-shaped, inverted T shaped, etc…), finding a care provider willing to accept the patient’s right to bodily autonomy can be extremely difficult. We feel Practice Bulletin 184 will not help these patients regain their right to “accept increased levels of risk”, or to exercise their right to give informed consent. As stated in “Safe Prevention of the Primary Cesarean”, childbirth “by its very nature carries potential risks for the woman and her baby, regardless of the route of delivery”. We agree with ACOG that pregnancy is “not an exception to the principle that a decisionally capable patient has the right to refuse treatment, even treatment needed to maintain life. Therefore, a decisionally capable pregnant woman’s decision to refuse recommended medical or surgical interventions should be respected”. We feel ACOG’s label of contraindication regarding people with special scars attempting TOLAC will limit the patient’s ability to exercise their right to give informed consent and informed refusal. We do, however, thank ACOG for their continued support of TOLAC for people with a prior low-vertical incision.

The International Cesarean Awareness Network supports a person’s right to choose their preferred birth location and mode, and to choose who will provide their prenatal and delivery care. We believe it is imperative that the public becomes educated on their rights and options in childbirth, and on the risks involved with each option. A person cannot give true informed consent without first being given unbiased counseling regarding the risks and benefits of all options. Patients should be their own best advocate, and that involves researching and studying childbirth, and human rights in the medical system. We greatly appreciate the time ACOG put into updating their VBAC guidelines, and we are extremely hopeful that this information will provide greater access to evidence-based care for most people. We challenge ACOG to reconsider its endorsement of web-based VBAC calculators by evaluating the effect it will have on all people considering a TOLAC, especially People of Color and People of Size, to publicly restate their previous clarification on VBA2C-  that “most women with two previous low-transverse cesarean deliveries are candidates for and should be offered TOLAC and counseled based on the combination of individual factors that affect their risk and probability of achieving a successful VBAC”, and to reconsider their stance against planned VBAC for those with special scars.

International Cesarean Awareness Network

Board of Directors

Lindsey Seger, President

Justen Alexander, Vice President

Samantha Wall, Secretary

Ann Marie Walsh, Chapter Director

Brianna Barker, Advocacy Director


https://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery

https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Refusal-of-Medically-Recommended-Treatment-During-Pregnancy

https://www.ican-online.org/huntsville/2016/12/15/should-mothers-be-denied-option-of-vba2c-acog-clarifies/

https://www.acog.org/Patients/FAQs/Vaginal-Birth-After-Cesarean-Delivery-Deciding-on-a-Trial-of-Labor-After-Cesarean-Delivery

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics, & Grobman, W., MD. (2017). Vaginal Birth After Cesarean Delivery. Clinical Management Guidelines for Obstetrician-Gynecologists, 130(5), practice bulletin 184.

Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:693–711.

Refusal of medically recommended treatment during pregnancy. Committee Opinion No. 664. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e175–82.

Vaginal Birth After Cesarean Delivery – Deciding on a Trial of Labor After Cesarean Delivery. Frequently asked questions. Labor, delivery, and postpartum care.  FAQ070.  American College of Obstetricians and Gynecologists.  https://www.acog.org/Patients/FAQs/Vaginal-Birth-After-Cesarean-Delivery-Deciding-on-a-Trial-of-Labor-After-Cesarean-Delivery.  2011 August.

“ICAN of Huntsville » Should Mothers Be Denied Option of VBA2C? ACOG Clarifies.” ICAN of Huntsville, ICAN of Huntsville Leadership, 15 Dec. 2016, www.ican-online.org/huntsville/2016/12/15/should-mothers-be-denied-option-of-vba2c-acog-clarifies/.

Filed Under: Advocacy, Education, ICAN, VBAC Tags: ACOG, Education, VBAC

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