From the National Institute of Health Consensus Development Conference, Vaginal Birth After Cesarean: New Insights, Bethesda, Md.
The NIH panel that was charged with examining the reasons for the continuing downturn in vaginal birth after C-sections had a tough enough job in reaching a consensus today. It was faced with a lack of evidence in many crucial areas, such as comparative outcomes for VBAC and elective repeat cesareans.
But the panel also had to contend with some thorny ethical and political issues. Thus, unlike many other such consensus panels, this expert committee faced an aggressively questioning audience that, at times, was downright hostile.
Why? Over the past two decades, many women have taken an increasingly activist role in the debate over where and how they will give birth. With the growth of the Internet has come a concomitant increase in forums and Web sites devoted to pregnancy issues. The rise in primary and repeat cesareans has been no secret.
The consensus statement found that some 30% of hospitals are now refusing to perform VBAC, which has become popularly known as “a VBAC ban.” The National Organization for Women (NOW) passed a resolution in 2005 opposing institutional policies that essentially banned VBAC. The NIH panel also confirmed that physicians increasingly prefer cesareans, partly because they harbor what the evidence shows is an outsized fear of career-ending lawsuits.
While the panel’s consensus statements in those areas drew praise, more than a handful of nurses, midwives, gynecologists and advocates accused the panel of ignoring a woman’s right to choose, or more specifically, a woman’s right to refuse a cesarean.
Some said that the right had been established by legal precedent.
The panel’s ethicist, Laurence McCullough, Ph.D., of the Baylor College of Medicine in Houston, said that it was an extremely complicated issue that was outside the panel’s purview. Other panel members noted the tension in the law that forced physicians to balance the mother’s life against that of the fetus. Critics were not satisfied.
Should the medical establishment be leading the way on this informed consent issue? Or is this an issue that should be settled by the courts or the government?
— Alicia Ault (on Twitter @aliciaault)