Inconsistent Evidence: Analysis of Six National Guidelines for Vaginal Birth After Cesarean Section

Foureur, Maralyn; Ryan, Clare; Nicholl, Michael C.; Homer, Caroline

doi:10.1111/j.1523-536x.2009.00372.x

Cited by 42 publications

(26 citation statements)

References 24 publications

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“…For example, the Royal College of Obstetricians and Gynaecologists' Green-Top Guidelines [35] state that "planned VBAC should be attempted in a suitably staffed and equipped delivery suite, with continuous intrapartum care and monitoring and available resources for immediate cesarean section and advanced neonatal resuscitation" [p. 9]. Although this recommendation is based primarily on consensus and expert opinion rather than empirical evidence [38], it is clear that there is a level of international consensus that VBAC requires close vigilance during labor. Unfortunately, however, the recommended guidelines do not provide solutions to the real-world problem of staffing obstetrical units to meet the needs of women with a previous cesarean.…”

Section: Discussionmentioning

confidence: 99%

Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study

Cox

2011

BMC Pregnancy Childbirth

112

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BackgroundWomen's access to vaginal birth after cesarean (VBAC) in the United States has declined steadily since the mid-1990s, with a current rate of 8.2%. In the State of Florida, less than 1% of women with a previous cesarean deliver vaginally. This downturn is thought to be largely related to the American College of Obstetricians and Gynecologists (ACOG) VBAC guidelines, which mandate that a physician and anesthesiologist be "immediately available" during a trial of labor. The aim of this exploratory qualitative study was to explore the barriers associated with the ACOG VBAC guidelines, as well as the strategies that obstetricians and midwives use to minimize their legal risks when offering a trial of labor after cesarean.MethodsSemi-structured interviews were conducted with 11 obstetricians, 12 midwives, and a hospital administrator (n = 24). Interviews were recorded and transcribed verbatim, and thematic analysis informed the findings.ResultsFear of liability was a central reason for obstetricians and midwives to avoid attending VBACs. Providers who continued to offer a trial of labor attempted to minimize their legal risks by being highly selective in choosing potential candidates. Definitions of "immediately available" varied widely among hospitals, and providers in solo or small practices often favored the convenience of a repeat cesarean delivery rather than having to remain in-house during a trial of labor. Midwives were often marginalized due to restrictive hospital policies and by their consulting physicians, even though women with previous cesareans were actively seeking their care.ConclusionsThe current ACOG VBAC guidelines limit US obstetricians' and midwives' ability to provide care for women with a previous cesarean, particularly in community and rural hospitals. Although ACOG has proposed that women be allowed to accept "higher levels of risk" in order to be able to attempt a trial of labor in some settings, access to VBAC is unlikely to increase in Florida as long as systemic barriers and liability risks remain high.

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Section: Discussionmentioning

confidence: 99%

Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study

Cox

2011

BMC Pregnancy Childbirth

112

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“…10,[35][36][37] Comparisons are challenging because of variations in study reports and limitations in data management and analysis. 38 This inconsistent information could understandably create confusion for pregnant women. 38 Nevertheless, women should be informed that both birth methods are not risk free.…”

Section: Literature Reviewmentioning

confidence: 99%

“…38 This inconsistent information could understandably create confusion for pregnant women. 38 Nevertheless, women should be informed that both birth methods are not risk free. 36,37 A successful VBAC rate of 60-82% has been shown with no significant difference in maternal death and hysterectomy between VBAC and repeat CS.…”

Section: Literature Reviewmentioning

confidence: 99%

Women's knowledge of options for birth after Caesarean Section

Chen

Hancock

2012

Women and Birth

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“…'' 11(p29) Critical reviews of practice guidelines have shown them to vary considerably in the strength of evidence used in their development, the search methods employed to gather the evidence, and the demonstration of links between the evidence gleaned and the resulting practice recommendations. [12][13][14] With publication of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument in 2003 15 and recent expansion and improvement of the tool as the AGREE II, 16,17 it is now possible to address this variability in guideline quality by systematically evaluating key factors in guideline development. The AGREE II comprises 23 items within 6 domains: 1) scope and purpose; 2) stakeholder involvement; 3) rigor of development; 4) clarity of presentation; 5) applicability; and 6) editorial independence.…”

mentioning

confidence: 99%

Clinical practice guidelines for breast cancer rehabilitation

Harris

Schmitz

Campbell

et al. 2012

Cancer

115

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BACKGROUND: Despite strides in early detection and management of breast cancer, the primary treatments for this disease continue to result in physical impairments for some of the nearly 3 million people diagnosed annually. Over the past decade, evidence‐based clinical practice guidelines (CPGs) have been developed with goals of preventing and ameliorating these impairments. However, translation of these guidelines into clinical practice needs to be accelerated. METHODS: Relevant health science databases (2001‐2011) were searched to identify CPGs on breast cancer rehabilitation for the following impairments: upper extremity restrictions, lymphedema, pain, fatigue, chemotherapy‐induced peripheral neuropathy, treatment‐related cardiotoxicity, bone health, and weight management. RESULTS: Recommendations from 19 relevant CPGs were first summarized by impairment within tables; commonalities across guidelines, within each impairment, were then synthesized within the article. The CPGs were rated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II); wide variability was noted in rigor of development, clarity of presentation, and stakeholder involvement. The most rigorous and comprehensive of those rated was the adult cancer pain guideline from the Scottish Intercollegiate Guidelines Network. CONCLUSIONS: Based on a large body of evidence published in recent years, including randomized trials and systematic reviews, there is an urgent need for updating the guidelines on upper extremity musculoskeletal impairments and lymphedema. Furthermore, additional research is needed to provide an evidence base for developing rehabilitation guidelines on management of other impairments identified in the prospective surveillance model, eg, arthralgia. Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.

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Inconsistent Evidence: Analysis of Six National Guidelines for Vaginal Birth After Cesarean Section

Abstract: VBAC guidelines are characterized by quasi-experimental evidence and consensus-based recommendations, which lead to wide variability in recommendations and undermine their usefulness in clinical practice.

Cited by 42 publications

References 24 publications

Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study

Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study

Women's knowledge of options for birth after Caesarean Section

Clinical practice guidelines for breast cancer rehabilitation

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