CIMS Calls for Fewer First Cesareans, No Prostaglandin Inductions of VBACs.

Editor's Note: This is in response to the study published last month in the New England Journal of Medicine. Look for a thorough rebuttal of the NEJM study in the next issue of Special Delivery.

In a statement released July 12, 2001, the Coalition for Improving Maternity Services (CIMS) responded to a recent New England Journal of Medicine article on vaginal birth after cesarean (VBAC). CIMS calls for fewer first cesareans and avoiding the use of prostaglandin induction births after a previous cesarean. CIMS also calls for continuing the use of VBACs as safer for women and equally safe for babies as repeat cesareans.

The CIMS Statement reads as follows: The most important finding of the recent New England Journal of Medicine study on vaginal birth after cesarean (VBAC) was the strong agreement with previous studies that prostaglandin induction is less safe for women and their babies than a normal labor, an induction without prostaglandin, or a repeat cesarean.

The study data do not support limiting VBACs because the data covered only uterine rupture. This study did not compare all of the risks and benefits over repeat cesarean versus VBAC. VBAC is as safe as repeat cesarean for babies and safer for women as shown in more than two-dozen studies totaling more than 50,000 women. Women having planned repeat cesareans had significantly more medical complications than women having VBACs.

CIMS supports `mother-friendly childbirth,' which includes giving women accurate information, avoiding unnecessary interventions, and offering access to professional midwifery care. The midwifery model of care supports and protects the normal birth process and is the safest and most appropriate kind of care for the majority of women and their babies, according to studies from around the world. Increased use of the midwifery model of care would reduce the primary cesarean section rate and reduce the use of induction for VBACs.

CIMS agrees with the advice of the American College of Nurse--Midwives that `women need unbiased, individualized information and, if they desire, a safe and supportive place to attempt a VBAC.'"

--The Coalition for Improving Maternity Services (CIMS--pronounced "kims") includes more than 50 organizations representing 90,000 members, and hundreds of individuals prominent in the fields of maternal and infant care. The coalition collaborates on public education, evidence-based care issues, and designating facilities and services as Mother-Friendly. The mission of CIMS is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-baby-family friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.