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VBAC Revisited: Avoiding the Swinging Pendulum

Hours: 1.25

Best suited for: Obstetrical practitioners and anesthesiologists

Course Description
The risks and benefits of VBAC present a complex challenge. Pressures to lower cesarean rates run headlong into the question of whether prompt operative intervention can be guaranteed in an emergency. The reconsideration of previously-established guidelines and appeals from natural childbirth advocates add to the complexity, especially as acceptable risk differs from patient to patient.
How should you counsel women about trial of labor after cesarean?
How should you manage their labor?
In this 1.25 hour webinar, obstetrical leader Dr. Steven L. Clark will address these questions through a reasoned approach to VBAC based on careful patient selection and a focus on patient safety.

Please note:
A Practice Bulletin published in November 2017 by the American College of Obstetricians and Gynecologists (ACOG) recommends that hospitals doing VBACS need to be able to provide an emergency Cesarean section, revised from an earlier guideline that stipulated “immediately available” personnel for emergency Cesarean.
Additionally, Dr. Clark responds to a question within the webinar about double layer versus single layer uterine closure. His response should be reconsidered in the light of more current studies. You are encouraged to access resources published by ACOG at www.acog.org/More-info/VBAC, and to read the ACOG Practice Bulletin Number 184 by clicking here.

Learning Objectives
Participants will leave this activity able to:
  • Implement careful pre-labor stratification of women considering VBAC.
  • Use predicted success rates and medical evidence to counsel prenatal patients with a prior cesarean birth.
  • Ensure immediate availability of emergency operative intervention for patients undergoing trial of labor after cesarean.

Faculty Information
Steven L. Clark, M.D. is a maternal-fetal medicine specialist and is professor of Obstetrics and Gynecology at Baylor College of Medicine in Houston. He was formerly Medical Director of Women’s and Children’s Clinical Services for the Hospital Corporation of America. He has served as president of the Society for Maternal Fetal Medicine, Chair of the ACOG Technical Bulletin Committee and as a board examiner. He has served on several ACOG task forces and committees and as patient safety consultant to the U.S. Air Force Surgeon General. He currently serves on the Scientific Advisory Board for United Health Care, and on the Joint Commission Perinatal Advisory Panel. He has published over 200 scientific articles and chapters, and edited several textbooks, including Critical Care Obstetrics. He serves as a peer reviewer for 23 national and international scientific journals.

Planning Group
Angela Chien, MD, Obstetrics, EvergreenHealth, Kirkland, WA
Leslee Goetz, MN, RNC-OB, Manager Family Childbirth Center, Swedish Ballard, Seattle, WA
Kym Lewis Shepherd, Director, Complex Litigation, Physicians Insurance, Seattle, WA
Linda Robinson, MSN, RNC, Perinatal Clinical Nurse Specialist, Group Health Cooperative, Seattle, WA
Celia Smith, CHCP, Director, Continuing Medical Education, Physicians Insurance, Seattle, WA

CME Information
Physicians in Washington who complete this course will fulfill the risk management-education requirement mandated by the Washington Health Services Act of 1993.

Category 1 credit is applicable throughout the United States.
Estimated time to complete this activity: 1 hour

Physicians Insurance/Experix is accredited by the Washington State Medical Association to provide continuing medical education for physicians.
Physicians Insurance/Experix designates this live activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity meets the criteria for up to 1.25 hours of Category I CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission.

Neither the presenter nor the planner for this activity have any relevant financial relationships to disclose.

The content will not include mention of unapproved or investigational uses or products or devices.


Resolution of Conflicts of Interest
Physicians Insurance/Experix has implemented a process to resolve conflicts of interest for each continuing medical education activity, to help ensure content objectivity, independence, fair balance, and content that is aligned with the interest of the public. Conflicts, if any, are resolved through a peer-review process.

Member and Subscriber Access
Interested in a CME program like this for your team or facility? Contact us to schedule it and talk about pricing.

Original release: January 2015
Last reviewed: January 2018
Expiration: January 2019

After You Complete the Course

Following completion of the quiz, you will be asked to fill out a brief online evaluation form, after which you may print your certificate of participation. Your participation is automatically recorded by Physicians Insurance without any additional steps on your part.

This course is offered through Experix, a wholly owned subsidiary of Physicians Insurance, and is based on more than 30 years' experience in providing continuing medical education. This course is complimentary for Physicians Insurance members.

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