NIH Consensus Development Conference on
Vaginal Birth After Cesarean:
New Insights
March 8–10, 2010
Bethesda, Maryland
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Eunice Kennedy Shriver National Institute of Child Health and Human Development
Office of Medical Applications of Research
of the National Institutes of Health
Co-sponsor
National Institute of Nursing Research
Office of Research on Women's Health
The Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention provided additional conference development support.
Monday, March 8, 2010
| 8:30 a.m. | Introduction and Opening Remarks Alan E. Guttmacher, M.D. Acting Director Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health |
| 8:40 a.m. | Charge to the Panel Jennifer M. Croswell, M.D., M.P.H. Acting Director Office of Medical Applications of Research Office of the Director National Institutes of Health |
| 8:50 a.m. | Conference Overview and Panel Activities F. Gary Cunningham, M.D. Panel and Conference Chairperson Beatrice and Miguel Elias Distinguished Chair in Obstetrics and Gynecology Professor, Obstetrics and Gynecology University of Texas Southwestern Medical Center at Dallas |
| 9:00 a.m. | Overview of the Topic Caroline Signore, M.D., M.P.H. Medical Officer Pregnancy and Perinatology Branch Center for Developmental Biology and Perinatal Medicine Eunice Kennedy Shriver National Institute of Child Health and Human Development |
| I. | What Are the Rates and Patterns of Utilization of Trial of Labor After Prior Cesarean, Vaginal Birth After Cesarean, and Repeat Cesarean Delivery in the United States? |
| 9:15 a.m. | Trends and Patterns of VBAC Availability in the United States Kimberly D. Gregory, M.D., M.P.H. Vice Chair, Womens Healthcare Quality and Performance Improvement Department of Obstetrics and Gynecology Cedars Sinai Medical Center |
| II. | Among Women Who Attempt a Trial of Labor After Prior Cesarean, What Is the Vaginal Delivery Rate and the Factors That Influence It? |
| 9:35 a.m. | Evidence-based Practice Center Presentation I: Trial of Labor, Vaginal Delivery Rates, and Relevant Factors Karen B. Eden, Ph.D. Investigator/Associate Professor Department of Medical Informatics and Clinical Epidemiology School of Medicine Oregon Health & Science University |
| 9:55 a.m. | Success Rates and Predicting Successful VBAC William A. Grobman, M.D., M.B.A. Associate Professor Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Feinberg School of Medicine Northwestern University |
| 10:15 a.m. | Discussion |
| III. | 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? |
| 10:45 a.m. | Evidence-based Practice Center Presentation II: Maternal Benefits and Harms, and Relevant Factors Jeanne-Marie Guise, M.D., M.P.H. Principal Investigator/Associate Professor Departments of Obstetrics and Gynecology, and Medical Informatics and Clinical Epidemiology School of Medicine Oregon Health & Science University |
| 11:05 a.m. | Delivery After Previous Cesarean: Short Term Maternal Outcomes Mona T. Lydon-Rochelle, Ph.D., M.P.H., C.N.M. Associate Professor/Perinatal Epidemiologist National Perinatal Epidemiology Centre Anu Research Centre Department of Obstetrics and Gynaecology and Department of Epidemiology & Public Health University College Cork |
| 11:25 a.m. | Discussion |
| 11:45 a.m. | Lunch Panel Executive Session |
| 12:45 p.m. | Delivery After Previous Cesarean: Long Term Maternal Outcomes Robert M. Silver, M.D. Professor Chief, Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology University of Utah Health Sciences Center |
| 1:05 p.m. | Predicting Uterine Rupture Mark B. Landon, M.D. Professor Director, Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Ohio State University College of Medicine |
| 1:25 p.m. | Discussion |
| IV. | 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? |
| 1:45 p.m. | Evidence-based Practice Center Presentation III: Infant Benefits and Harms, and Relevant Factors Cathy Emeis, Ph.D., CNM Investigator/Assistant Professor Department of Primary Care School of Nursing Oregon Health & Science University |
| 2:05 p.m. | Delivery After Previous Cesarean: Short Term Infant Outcomes Lucky Jain, M.D., M.B.A. Richard W. Blumberg Professor and Executive Vice Chairman Department of Pediatrics Emory University School of Medicine |
| 2:25 p.m. | Delivery After Previous Cesarean: Long Term Infant Outcomes T. Michael OShea, M.D., M.P.H. Professor Chief, Division of Neonatology Department of Pediatrics Baptist Medical Center Wake Forest University |
| 2:45 p.m. | Synthesis: Weighing Risks to Mother and Infant George A. Macones, M.D., M.S.C.E. Elaine and Mitchell Yanow Professor and Chairman Department of Obstetrics and Gynecology Washington University School of Medicine |
| 3:05 p.m. | Discussion |
| V. | What Are the Non-Medical Factors That Influence the Patterns and Utilization of Trial of Labor After Prior Cesarean? |
| 3:45 p.m. | Trial of Labor versus Elective Repeat Cesarean: An Administrator's Perspective Michael L. Socol, M.D. Thomas J. Watkins Memorial Professor and Vice Chair Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Feinberg School of Medicine Northwestern University |
| 4:15 p.m. | Evaluating Professional Society Guidelines on VBAC Emmanuel Bujold, M.D., F.R.C.S.C. Department of Obstetrics and Gynaecology Faculté de Médecine Université Laval |
| 4:35 p.m. | Discussion |
| 5:00 p.m. | Adjournment |
Tuesday, March 9, 2010
| V. | What Are the Non-Medical Factors That Influence the Patterns And Utilization of Trial of Labor After Prior Cesarean? (Continued) |
| 8:30 a.m. | Trial of Labor versus Elective Repeat Cesarean: The Impact of Anesthesiologist Availability David J. Birnbach, M.D., M.P.H. Professor Department of Anesthesiology and Obstetrics and Gynecology Associate Dean and Director, Jackson Memorial Hospital Center for Patient Safety Miller School of Medicine University of Miami |
| 8:50 a.m. | Exploring the Immediately Available Physician Standard Howard Minkoff, M.D. Professor Department of Obstetrics and Gynecology SUNY-Brooklyn; Maimonides Medical Center |
| 9:10 a.m. | Understanding Risk, Patient and Provider Preferences, and Obstetric Decision Making Miriam Kuppermann, Ph.D., M.P.H. Professor of Obstetrics, Gynecology & Epidemiology University of California, San Francisco |
| 9:30 a.m. | Discussion |
| 10:00a.m. | The Medical Ethics of VBAC Anne D. Lyerly, M.D. Associate Professor Department of Obstetrics and Gynecology Faculty Associate, Center for the Study of Medical Ethics and Humanities Duke University |
| 10:20 a.m. | Mothers' Stories Rita Rubin Medical Reporter USA Today |
| 10:40 a.m. | Walking the Line: The Obstetric Provider Experience Chet Edward Wells, M.D. Professor Department of Obstetrics and Gynecology University of Texas Southwestern Medical Center at Dallas |
| 11:00 a.m. | Discussion |
| 11:30 a.m. | Adjournment |
Wednesday, March 10, 2010
| 9:00 a.m. | Presentation of the Draft Consensus Statement |
| 9:30 a.m. | Public Discussion |
| 11:00 a.m. | Adjournment Panel Meets in Executive Session |
| 2:00 p.m. | Press Telebriefing |
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