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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
3375.0: Monday, December 12, 2005 - 5:05 PM

Abstract #117898

Disturbing trends in the use of epidemiologic research on VBAC in North America and their impact on practice

Kenneth C. Johnson, PhD, Epidemiologic Consultant, 36 Glen Ave, Ottawa, ON K1S 2Z7, Canada, 613 730 0282, Ken_LCDC_Johnson@HC-SC.GC.CA and Betty-Anne Daviss, RM, CPM, MA, The Midwifery Collective of Ottawa, 36 Glen Ave, Ottawa, ON K1S 2Z7, Canada.

Over the last two decades, maternity and child health care practitioners have benefited from an international research collaboration based in Britain called the Cochrane Collaboration. By producing systematic reviews of the scientific literature on controversies in obstetric care, the Cochrane Collaboration has laid to rest some obstetric myths, including whether or not several procedures done for decades are really of any worth (e.g. episiotomies, routine electronic fetal monitoring). Unfortunately, rather than adopting the spirit of the Cochrane Collaboration, there seems to be an increased trend in North America towards utilizing single new studies in isolation. Three systematic reviews in the 1990s provided a wealth of evidence in support of the safety of VBAC. Unfortunately, highly-publicized recent single studies have turned the obstetrical world's back on the weight of evidence for VBAC. Although the absolute risk associated with VBAC is very low, women are increasingly being denied the option of having a VBAC. A national study examining the outcomes of women planning VBACs in birth centers made conclusions that were essentially at odds with the results – concluding that women should be denied their right to deliver in birth centers even though the overall rate of serious adverse outcomes associated with attempted VBACs was the same for birth centers as for spontaneous, term VBACs at a leading U.S. tertiary care hospital, but with a 43% lower uterine rupture rate. This presentation will examine the epidemiologic evidence on VBAC safety and the impact of these recent studies on VBAC availability.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

Keywords: Maternal and Child Health, Epidemiology

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Who's Left to Catch the Baby?

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA