Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117898

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

• To describe the basic aspects of weight of evidence and its role in making decisions in women’s care.
• To articulate some basic concepts of meta-analysis, its application to VBAC, and the overall conclusion of the 3 VBAC meta-analyses in the literature.
• To articulate some shortcomings of using individual studies to draw conclusions about VBAC, the impact of media attention on these individual studies, and the impact of theses studies on practice.
• To describe the key epidemiologic findings of the NACC VBAC study and to discuss why the conclusions presented are at odds with the results of the study.

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.