Offering Labor After Cesarean During COVID-19
As I have watched COVID-19 unfold in the United States, I have heard a lot of distressing stories about how this pandemic is impacting maternity care and birthing people.
People being told that they “have to” be induced or schedule a primary or repeat cesarean because of COVID-19.
But is this evidence based? What do we have in terms of research and what do national and international guidelines recommend? What can we learn from how hospitals have managed prior crises? How can we apply that to our current situation? And is it really a big deal if everyone has cesareans?
To answer these questions, I created a free training where you will learn:
- VBAC and Public Health: Mitigating Future Risks of Placenta Accreta [3:32]
- The Current Crisis: Reducing COVID-19 Transmission and Preserving Hospital Staff/ Resources [13:44]
- Mode of Delivery in the Time of COVID-19: What International and National Guidelines Recommend [18:00]
- PPE Recommendations: How VBAC Access Conserves PPE [31:13]
- Cesarean and Anesthetic Considerations: For COVID-19 Patients and Anaesthetists [37:38]
- ACOG Guidelines in Theory and Reality: Does ACOG Require 24/7 Anesthesia to Offer VBAC? [47:21]
- Supporting VBAC in Low Resource Settings: Case Studies and Consent Conversations [58:03]
Three things: One, note the timestamps above so if you want to fast-forward to a section, you can. Secondly, this training was current as of April 8, 2020, but information is changing fast. Finally, all of my resources are included below.
COVID-19 Guidelines
- American College of Obstetricians and Gynecologists. (2020). COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics.
- Centers for Disease Control and Prevention. (2020). Coronavirus Disease 2019: Healthcare Facility Guidance.
- Centers for Disease Control and Prevention. (2020). Coronavirus Disease 2019: Healthcare Professionals.
- Royal College of Obstetricians and Gynecologists. (2020). Coronavirus (COVID-19) Infection in Pregnancy.
- Royal College of Obstetricians and Gynecologists. (2020). Coronavirus infection and pregnancy.
- Society for Obstetric Anesthesia and Perinatology. (2020). Interim Considerations for Obstetric Anesthesia Care related to COVID19.
- Society of Obstetricians and Gynecologists of Canada. (2020). Updated SOGC Committee Opinion – COVID-19 in Pregnancy.
- World Health Organization. (2020). Q&A on COVID-19, Pregnancy, Childbirth and Breastfeeding.
Other Guidelines
- American College of Obstetricians and Gynecologists. (2011). Code of Professional Ethics.
- American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. (2018). ACOG Committee Opinion No. 7: Placenta accreta spectrum.
- American College of Obstetricians and Gynecologists. (2016). ACOG Committee Opinion No. 664. Refusal of medically recommended treatment during pregnancy.
- American College of Obstetricians and Gynecologists. (2019). ACOG Practice Bulletin No. 205. Vaginal birth after cesarean delivery. [As these interim guidelines are not available to the public as of yet, please refer to their 2017 guidelines as well as my commentary.]
COVID-19 Research/ Commentary
- Chen et al. (2020). Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients.
- Favre et al. (2020). Guidelines for pregnant women with suspected SARS-CoV-2 infection.
- Khan et al. (2020). COVID-19 infection during pregnancy: a systematic review to summarize possible symptoms, treatments, and pregnancy outcomes.
- Yue et al. (2020). Anaesthesia and infection control in cesarean section of pregnant women with coronavirus disease 2019 (COVID-19).
- Zhang et al. (2020). Anaesthetic managment and clinical outcomes of parturients with COVID-19: a multicentre, retrospective, propensity score matched cohort study.
- Zhong et al. (2020). Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single- centre, observational cohort study.
Staffing, Resources, & Hospital Days Research
- Capanna et al. (2020). Preparing an obstetric unit in the heart of the epidemic strike of COVID-19: quick reorganization tips.
- Curtin et al. (2015). Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013.
- Fobelets et al. (2018). Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost effectiveness analysis in four European countries.
- Fawsitt et al. (2013). At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery.
- Gilbert et al. (2013). Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort.
- Lebrun et al. (2020). COVID-19 Pandemic: Staged Management of Surgical Services for Gynecology and Obstetrics.
- Soremekun et al. (2011). Cancellation of Scheduled Procedures as a Mechanism to Generate Hospital Bed Surge Capacity—A Pilot Study.
VBAC/ Accreta Research
- Eshkoli et al. (2013). Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births.
- Gregory et al. (2008). Vaginal birth after cesarean: clinical risk factors associated with adverse outcome.
- Guise et al. (2010). Vaginal Birth After Cesarean: New Insights.
- Nair et al. (2015). Selected maternal morbidities in women with a prior caesarean delivery planning vaginal birth or elective repeat caesarean section: a retrospective cohort analysis using data from the UK obstetric surveillance system.
- Silver et al. (2006). Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries.
- Silver et al. (2010). Delivery after previous cesarean: Long-term maternal outcomes.
- Spong et al. (2007). Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery.
- Wen et al. (2004). Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery.
Hospital VBAC Policy Research
- Barger et al. (2012). A survey of access to trial of labor in California hospitals in 2012.
- Xu et al. (2019). Hospital variation in utilization and success of trial of labor after a prior cesarean.
If you enjoyed this training and are committed to increasing access to VBAC, continue the journey with me in professional membership.
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Jen Kamel
As a nationally recognized consumer advocate and Founder of VBAC Facts®, Jen helps perinatal professionals, and cesarean parents, achieve clarity on vaginal birth after cesarean (VBAC) through her educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. She speaks at conferences across the country, presents Grand Rounds at hospitals, advises advocates seeking legislative change in their state, and serves as a expert witness in legal proceedings. She envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support, so they can plan the birth of their choosing in the setting they desire.
Thanks, Jen. I thought it was a great training. Thanks for distilling some of the abundance of information on COVID-19, especially how it applies to birthing parents. I thought you did a great job of incorporating information on accreta and VBAC access generally, which I think are especially important because you will hopefully have people viewing this who are not familiar with your advocacy and therefore probably need to know this information. Good job!