VBAC or no VBAC? That is the ongoing question

Shared perception of the safety of a trial of labor after cesarean delivery among all participants appears to be the deciding factor in whether that option is offered, concludes a report by the Agency for Healthcare Research and Quality.

The definition of a safe birth and a safe trial of labor after cesarean delivery must be agreed upon by the patient, the healthcare provider, and the institution.

Once the definition of “safe” is achieved, best practices can be developed to attain that standard of safety.

The ongoing debate about whether a woman should attempt vaginal birth after a cesarean delivery (VBAC) comes down to the definition of what constitutes “safe,” according to a Future Research Needs Paper issued by the Agency for Healthcare Research and Quality (AHRQ).

Further, the definition of a “safe” trial of labor (TOL) after cesarean and of a “safe” birth in general must be agreed upon by the individual, the care provider, and the institution or care setting, according to the authors of the paper. As participants of the project explained, once “safe” is defined, then best practices for achieving safety can be identified and tested in other settings.

From May to June of 2011, AHRQ recruited a panel of national stakeholders-clinicians, consumer advocates, research funders, researchers, legal/liability experts, and hospital administrators-to identify and prioritize the top 10 future research needs related to VBAC. Prior evidence review and the 2010 National Institutes of Health Consensus Development Conference on the subject left unanswered questions, according to AHRQ.

Half of the top 10 research needs identified by the participants fell into the category of health systems and contextual issues; specifically, how services can be disseminated effectively to the community and to women in a way that reflects the kind of care that they desire.

The remaining identified needs fell into 2 categories. The first was that of standardized measurement and collection of data on short- and long-term maternal and infant clinical and psychosocial outcomes. The second had to do with understanding how women perceive the risks associated with TOL and the best way to communicate the risks associated with each mode of delivery after prior cesarean to enable patients to make informed choices about their care and experience.

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