Wednesday, September 29, 2010

Letter to ACOG President Dr. Richard Waldman

Florida Friends of Midwives has added our organization's name to a list of endorsers to the following letter from the Coalition for Improving Maternity Services. We encourage all who are in support of this letter to endorse it here.

Richard N. Waldman, MD
American College of Obstetricians and Gynecologists
PO Box 96920
Washington, DC 20090-6920

Dear Dr. Waldman:

The Coalition for Improving Maternity Services (CIMS) supports the March 2010 National Institutes of Health (NIH) Consensus Statement on VBAC (vaginal birth after cesarean) and welcomes the American College of Obstetricians and Gynecologists' (ACOG) revised guidelines, Vaginal Birth After Previous Cesarean Delivery (August 2010) aimed at providing women increased access to VBAC and clearly emphasizing women's autonomy and their right to make informed decisions about how they choose to give birth. However, CIMS is concerned that ACOG's unrevised recommendation that trial of labor after cesarean (TOLAC) should take place in hospitals where resources for emergency cesarean are "immediately available" will continue to deter providers and hospitals from supporting this option.

The NIH found that this "immediately available" recommendation was based on consensus and expert opinion rather than strong support from high-quality evidence. The NIH also reported that this recommendation has influenced about one-third of hospitals and one-half of physicians to no longer provide care for women who want a VBAC. All women in labor face unpredictable risks that may require an emergency cesarean, not just women laboring for a VBAC. This recommendation selectively applies a higher standard of safety for women who choose a trial of labor.

CIMS urges ACOG to reassess this specific guideline and remove the current barrier to women's access to VBAC.

In addition to respecting women's autonomy, the current guidelines emphasize the need for physicians to discuss the benefits and risks of both trial of labor and elective repeat cesarean early on in the pregnancy. This is a recommendation that CIMS strongly supports. The NIH identified the importance of evidence-based processes that incorporate women's values and preferences to help women with a previous cesarean make informed choices about mode of birth. Similarly, a key recommendation identified in the multi-stakeholder consensus report, Blueprint for Action: Steps Toward a High-Quality, High-Value, Maternity Care System is expanding the opportunities and capacity for a shared decision-making process and developing tools and resources to facilitate informed choices in maternity care.

In the light of these recommendations, CIMS urges ACOG to revise its patient education publications and on-line consumer resources to include comprehensive information on the benefits and risks of cesarean section and VBAC.

CIMS, whose mission is to promote the Mother-Friendly Childbirth Initiative, an evidence-based wellness model of maternity care that will improve outcomes and reduce costs, urges ACOG to reconsider the "immediately available" recommendation and update its decision-making consumer resources. We believe that ACOG can make an even greater impact on increasing VBAC, reducing cesareans, and ultimately avoiding unnecessary harms to mothers and infants.


Michelle Kendell, MBA, AAHCC
Chair, Coalition for Improving Maternity Services (CIMS)
On behalf of CIMS and the following organizational members of the Coalition for Improving Maternity Services (CIMS)

Co-Signed By:
Academy of Certified Birth Educators
American Association of Birth Centers
American College of Nurse-Midwives
The Big Push for Midwives
Birth Matters Virginia
Birth Network National
Birth Network of Santa Cruz
Choices in Childbirth
DONA International
International Childbirth Education Association (ICEA)
Lamaze International
Midwives Alliance of North America
North American Registry of Midwives
Our Bodies Ourselves
Perinatal Education Associates
Tatia Oden French Memorial Foundation
toLabor: The Organization of Labor Assistants for Birth Options and Resources
Where's My Midwife?

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