National Institutes Of Health Consensus Development Conference Statement On Vaginal Birth After Cesarean

Vaginal birth after cesarean (VBAC) describes vaginal delivery by a woman who has had a previous cesarean delivery. For most of the 20th century, once a woman had undergone a cesarean delivery, clinicians believed that her future pregnancies required cesarean delivery. Studies from the 1960s suggested that this practice may not always be necessary. In 1980, a National Institutes of Health (NIH) Consensus Development Conference Panel questioned the necessity of routine repeat cesarean deliveries and outlined situations in which VBAC could be considered. The option for a woman with a previous cesarean delivery to have a trial of labor was offered and exercised more often in the 1980s through 1996. Since 1996, however, the number of VBACs has declined, contributing to the overall increase in cesarean delivery (Figure 1). Although we recognize that primary cesarean deliveries are the driving force behind the total cesarean delivery rates, the focus of this report is on trial of labor and repeat cesarean deliveries. A number of medical and nonmedical factors have contributed to this decline in the VBAC rate since the mid-1990s, although many of these factors are not well understood. A significant medical factor that is frequently cited as a reason to avoid trial of labor is concern about the possibility of uterine rupture-because an unsuccessful trial of labor, in which a woman undergoes a repeat cesarean delivery instead of a vaginal delivery, has a a higher rate of complications compared to VBAC or elective repeat cesarean delivery. Nonmedical factors include, among other things, restrictions on access to a trial of labor and the effect of the current medical-legal climate on relevant practice patterns. To advance understanding of these important issues, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Medical Applications of Research of NIH convened a Consensus Development Conference on March 8-10, 2010. The conference was grounded in the view that a thorough evaluation of the relevant research would help pregnant women and their maternity care providers when making decisions about the mode of delivery after a previous cesarean delivery. Improved understanding of the clinical risks and benefits and how they interact with nonmedical factors also may have important implications for informed decisionmaking and health services planning. The following key questions were addressed by the Consensus Development Conference: 1. What are the rates and patterns of utilization of trial of labor after prior cesarean delivery, vaginal birth after cesarean delivery, and repeat cesarean delivery in the United States? 2. Among women who attempt a trial of labor after prior cesarean delivery, what is the vaginal delivery rate and the factors that influence it? 3. What are the short-and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms? 4. What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms? 5. What are the nonmedical factors that influence the patterns and utilization of trial of labor after prior cesarean delivery? 6. What are the critical gaps in the evidence for decisionmaking, and what are the priority investigations needed to address these gaps?

This is a comprehensive, one-stop online book relating to all areas of pregnancy and birth. The second edition of this easily searchable guide is edited by eminent experts in the field and includes new contributions from international authors. It will be an ideal reference for Maternal-Fetal Specialists and Generalists wanting an authoritative answer on any point. Key features: •Grouped in to six topics (modules) for convenience •Electronic search facility across all chapters •Approximately 700,000 words of text, 7000 references, 300 figures (including 100 in full colour), and 200 tables available to search Key topics: •All common pregnancy and birth related problems such as diabetes and pregnancy •Many rarer complications such as protozoan infections •Fetal assessment, which is absolutely central to MFM practice •Medico-legal aspects •Sickle cell disease – a major problem for patients of African descent New chapters include: •Recurrent early pregnancy losses •Invasive hemodynamic monitoring •Chronic and acute hypertension •Neurological disorders •Maternal obesity •Assessment of fetal genetic disorders •First and second trimester screening

The Straight Scoop on the Questions That Make You Blush Why do I feel turned on when breastfeeding? Could an epidural paralyze me? Am I awful for feeling sad my baby isn’t the sex I’d hoped for? In this comprehensive new book, doula and birth educator Bailey Gaddis offers frank girlfriend talk and expert advice about pregnancy, childbirth, and early motherhood. During her own pregnancy, Bailey had many unanswered questions she felt were too taboo or embarrassing to ask. To help other women have a more informed, less cringey experience, she went on to train as a birth professional, and her work has inspired this book. Bailey consulted with medical experts and psychologists to ensure accurate answers to the featured questions, and she presents her sought-after expertise to you with thoughtfulness and humor. Her accurate, nonjudgmental answers to even the most embarrassing or scary questions will help guide you through pregnancy and the first weeks of motherhood with greater calm and confidence.

Book discusses VBAC (vaginal birth after caesarean).

This book is a guide to labour and delivery management for trainees in obstetrics and gynaecology, and midwives. Divided into three sections, the text begins with detailed discussion on labour, from preparation before labour and delivery, through the different stages of labour, to postpartum care. The next section covers caesarean delivery, and the third, ‘special labour’ which explains labour complications, twins, prelabour rupture of membranes, and more. The book is authored by recognised experts from the USA and Italy, and is based on evidence from randomised controlled trials (RCTs). Clinical photographs, diagrams and tables further enhance learning. Key points Guide to labour and delivery management for trainees in obstetrics and gynaecology, and midwives Text based on evidence from randomised controlled trials (RCTs) Recognised author team from USA and Italy Includes clinical photographs, diagrams and tables

Now in a fully updated Fifth Edition, Shnider and Levinson's Anesthesia for Obstetrics, continues to provide the comprehensive coverage that has made it the leading reference in the field. The rising number of Cesarean births and the more advanced age of first-time mothers in the United States have brought with them an increased risk for complications, making the role of the obstetric anesthesiologist increasingly important. This comprehensive reference addresses maternal and fetal physiology; fetal assessment; anesthesia and analgesia in both vaginal and Ceserean delivery; neonatal well-being; management of fetal, maternal, and anesthetic complications; and management of coexisting disorders in the mother. The Fifth Edition includes a new editorial team, a new full-color format, and new sections on Assessment of the Fetus, Anesthesia for Cesarean Delivery; Neonatal Well-Being: Old and New Concepts; Ethical, Medical, and Social Challenges and Issues; Maternal Safety, Difficult and Failed Intubation, Morbidity, and Mortality; and Anesthetic Considerations for Reproductive, In-Utero, and Non-Obstetric Procedures