Latest news with #ACOG
Yahoo
17 hours ago
- Health
- Yahoo
As new variant spreads, what's the latest COVID-19 vaccine guidance? It's complicated.
As a new COVID-19 variant takes over in the U.S., guidance surrounding vaccines has become increasingly confusing. Changes in vaccination guidelines, ever-evolving variants and strains, along with threats to health insurance, have sent average Americans looking for the latest recommendations as members of the federal government often conflict with independent medical agencies and healthcare professionals. In the two weeks leading up to June 21, the Centers for Disease Control and Prevention (CDC) reported just shy of 14,500 positive COVID tests, and while hospitalizations and deaths are fortunately down significantly since the pandemic's peak, vulnerable people are still grappling with limiting their risk amid changing practices. Having trouble keeping track of variants and vaccines? Here's what we know. NB.1.8.1 is one of the latest variants of COVID-19, a "slightly upgraded version" of the LP.8.1 variant that is prominent right now, Subhash Verma, microbiology and immunology professor at the University of Nevada, Reno, previously told USA TODAY in May. Verma previously stated that NB.1.8.1 may be transferred more easily than LP.8.1. Additionally, he noted that NB.1.8.1 can evade antibodies created by vaccines or past infections more easily than LP.8.1. In early April, NB.1.8.1 accounted for 0% of COVID cases in the U.S. In the two weeks ending June 21, it accounted for the majority of cases at 43%, according to the CDC. The variant has similar symptoms to other strains, including fever or chills, cough, shortness of breath or difficulty breathing, sore throat, congestion or a runny nose, new loss of taste or smell, fatigue, muscle or body aches, headache, nausea or vomiting. One of its more unique features is "razor blade throat," reported by patients as an exceptionally sore throat. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. said on May 27 that the COVID-19 vaccine would no longer be included in the CDC's recommended immunization schedule for healthy children and pregnant women, a move that broke with previous expert guidance and bypassed the normal scientific review process. Under the changes, the only people who will be recommended for COVID-19 vaccines are those over 65 and people with existing health problems. This could make it harder for others who want the COVID-19 vaccine to get it, including health care workers and healthy people under 65 with a vulnerable family member or those who want to reduce their short-term risk of infection. The American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP), among other organizations, issued statements condemning the change, with the ACOG saying it was "...concerned about and extremely disappointed by the announcement that HHS will no longer recommend COVID-19 vaccination during pregnancy." "It is very clear that COVID-19 infection during pregnancy can be catastrophic and lead to major disability, and it can cause devastating consequences for families. The COVID-19 vaccine is safe during pregnancy, and vaccination can protect our patients and their infants after birth," President Steven J. Fleischman said in a statement. Insurance coverage typically follows federal recommendations, so anyone who is healthy and under 65 is likely to have to pay out of pocket to get the shot, which runs about $200, if they can get it. It's not clear what insurance companies will do about the new recommendations. The American Medical Association (AMA) and American Academy of Pediatrics (AAP), in partnership with other professional medical organizations, broke from RFK and HHS after this announcement, sharing plans to develop their own guidelines independent of the government organization. In an open letter signed by 80 medical organizations across the country and published on June 25, the AMA called for physicians, healthcare networks and insurance companies to continue supporting "evidence-based immunizations to help prevent severe disease and protect public health." "Vaccines for influenza, RSV, and COVID-19 remain among the best tools to protect the public against these illnesses and their potentially serious complications—and physicians are among the most trusted voices to recommend them. We come together as physicians from every corner of medicine to reaffirm our commitment to these lifesaving vaccines," the letter said. "Recent changes to federal immunization review processes raised concerns across the medical and public health community. In this moment of uncertainty, physicians must align around clear, evidence-based guidance for patients." The AAP likewise said in a June 26 statement that it will "continue to publish its own evidence-based recommendations and schedules." AAP President Susan J. Kressly said the creation of federal immunization policy is 'no longer a credible process," adding, "...we're not stepping back, we're stepping up. The AAP will continue to publish our own immunization schedule just as we always have, developed by experts, guided by science, trusted by pediatricians and families across the country.' These latest independent guidelines have yet to be released. Meanwhile, the new Advisory Committee on Immunization Practices (ACIP) gathered for the first time on June 25 in a meeting that drew criticism from some experts. RFK fired all 17 original members of the committee on June 9, replacing them with members that critics have called unqualified. Some of the members, like Kennedy, have a history of anti-vaccine advocacy, prompting backlash that had doctors and organizations calling for a delay in the meeting. Anti-vaccine sentiments were repeated by ACIP Chair Martin Kulldorf at the meeting, who said the panel will be "investigating" MMR and childhood vaccines. The CDC panel also reviewed data about COVID-19 vaccines, questioning their safety and effectiveness. They also raised questions about the study design, methodologies and surveillance monitoring systems behind the data, which Dr. Pamela Rockwell, clinical professor of family medicine at the University of Michigan Medical School, addressed as a standard of medical research. "Our efforts, through a very robust system of checks and balances, are to create vaccines and vaccination programs that result in the most benefit with the least harm," said Dr. Gretchen LaSalle, a family physician in Spokane, Washington, who represented the American Academy of Family Physicians. Despite this, the committee didn't vote on COVID-19 vaccine recommendations for the fall and isn't expected to reconvene until 'September/October,' according to the CDC website. ACIP commitee: Inside the unusual, RFK-appointed panel that's deciding on childhood vaccines The FDA likewise announced updated requirements for mRNA COVID-19 vaccine warning labels on June 25, which apply to Comirnaty by Pfizer Inc. and Spikevax by ModernaTX Inc. Prescribing information will now include warnings of the connection between the vaccines and a rare side effect that causes inflammation of the heart muscle and lining. The new warning label discloses the risk of myocarditis, which appeared in 8 cases per 1 million people who got the 2023-2024 COVID shots between the ages of 6 months and 64 years old, mostly commonly among males aged 12 to 24. The previous label, which also disclosed the risk, said the problem mostly occurred in minors aged 12-17. Despite the back-and-forth in the U.S., the World Health Organization (WHO) has kept its recommendation consistent. Currently approved COVID-19 vaccines are expected to remain effective against the NB.1.8.1 variant, it said. In a webpage dated Jan. 7, the CDC advised that everyone over the age of six months get the 2024-2025 COVID-19 vaccine, specifically the 2024-2025 Moderna COVID-19 Vaccine. The page has since been updated with a banner, reading "COVID-19 vaccine recommendations have recently been updated for some populations. This page will be updated to align with the updated immunization schedule." The original recommendations align with the WHO's current guidelines. WHO, AMA, AAP and existing standards recommend that people who have never received a COVID-19 vaccine, are age 65 and older, are immunocompromised, live at a long-term care facility, are pregnant, breastfeeding, trying to get pregnant, and/or want to avoid getting long COVID, should get the vaccine, especially. Contributing: Greta Cross, Adrianna Rodriguez, USA TODAY This article originally appeared on USA TODAY: What are the latest COVID vaccine guidelines for this summer?
Forbes
3 days ago
- Health
- Forbes
A New Tool Could Make IUD Insertions Less Painful — It's Just In Time
A classic tenaculum (left) to grab and pull the cervix during IUD insertions and the new tool ... More Aspivix is offering to replace it (right). In August last year, the Center of Disease Control and Prevention (CDC) in the U.S., finally communicated what many women have claimed for years: pain during gynecological procedures, especially intrauterine devices (IUD) insertions, is often underestimated and poorly managed. The agency called for better care—more information, more options, and actual pain relief. Now, the American College of Obstetricians and Gynecologists (ACOG) has adapted to the request. The new guidelines emphasize the need to offer patients a range of pain management options for all in-office gynecological procedures. One Swiss company might have played a role in this change; Aspivix, based in Lausanne. Aspivix has developed Carevix®, a new non-traumatic cervical stabilizer designed to replace the tenaculum. It's the pointed, clamp-like tool that's used to grab and pull the cervix during IUD insertions and other procedures. It's often the source of the sharpest pain—yet many patients are not told what to expect, and almost none are offered pain relief. The cervix is packed with nerves, and especially for women who haven't given birth (nulliparous patients), the pain can be intense. Some have described it as 'as painful as giving birth, or worse.' Carevix® works by gently holding the cervix in place with suction rather than piercing it. That change may sound small, but the impact is clear: less pain, less bleeding, and improved experiences. A segment on the US TV show CBS Mornings showed the difference between the traditional tenaculum and Carevix. The side-by-side comparison makes it obvious why women would prefer the new tool. Watch it here. Aspivix has conducted a randomized controlled trial with the University Hospitals in Geneva and Lausanne, showing that Carevix® significantly reduced pain and bleeding during IUD insertion compared to the tenaculum. The results were published in the journal Contraception. To move into the U.S. market, Aspivix has partnered with Columbia University in New York and IU Health in Indianapolis for a follow-up clinical study, as well as with the Women's Health clinics, Tia Health, across the country. The U.S. study, led by Professor Jeffrey Peipert and Dr. Alissa Conklin, is still ongoing, but the early experience is promising. Dr. Conklin, who specializes in trauma-informed care, uses Carevix® routinely and she says that nearly all patients prefer it when given the option. The scope now is to include other cervical exams and other office procedures. That's in line with the new ACOG guidance, which applies to a wide range of interventions that require cervical stabilization such as endocervical biopsies, hysteroscopies and in IVF Changing clinical practice isn't just about launching a product. Aspivix has spent a lot of time working with gynecologists and midwives, identifying early adopters, and helping them test the device. Ikram Guerd, General Manager for Aspivix' U.S. branch, states that 'It's all about education. Transforming women's healthcare starts with education—at every level. We must train the next generation of clinicians to embrace innovation, empower women to understand their choices and ask for better care, and encourage men and investors to challenge the status quo. 'It already works' is no longer good enough when better, more respectful alternatives exist." Guerd and her team are also talking directly to women. A 20-second TikTok video explaining Carevix® posted by FemTech-promoter Dr. Brittany Barreto in 2023 reached over 3 million views and sparked thousands of comments. Many women described their own painful IUD insertions and wished they had known about alternatives. The video helped 'IUD' become one of TikTok's top health search terms. Aspivix is not the only company trying to change the use of painful gynecological tools. U.S.-based company Ceek Women's Health has designed a plastic speculum made from softer, body-friendly material. It's the same basic shape as the traditional speculum, but far more comfortable for patients. Other startups are also working on new designs and materials—and it seems that the IUD procedure is finally improving. Now, with both CDC and ACOG calling for better pain management, the timing is right. And with more women speaking up—online, in clinics, and in the media—the message is harder to ignore: painful tools don't have to be part of the experience.
Yahoo
17-06-2025
- Health
- Yahoo
Too many women 'grin and bear it' when getting an IUD. I helped write new pain management guidelines to change that.
Millions of American women have had an IUD (a tiny T-shaped contraceptive device) inserted into their uterus. Many of them likely walked into their doctor's office with a bit of anxiety, not knowing what exactly the procedure would feel like: Would it be just a pinch or would it be incredibly painful? (There is no shortage of viral horror stories.) Also, would your doctor take your pain seriously? Up until recently, there wasn't a standard of care for IUD pain management. Women are often told to pop over-the-counter pain relievers before coming in for the procedure, even though they don't always control the pain. Any pain relief beyond that has been up to the woman's doctor or hospital, and depended on what options they had available. That's changing thanks to new guidelines on pain management for IUD placement issued by the American College of Obstetricians and Gynecologists last month, which follows the Centers for Disease Control and Prevention's updated guidelines in 2024. ACOG called out the 'urgent need' for doctors to acknowledge and treat patient pain and added that patients should 'have more autonomy over pain control options for their health care.' Genevieve Hofmann is a nurse practitioner who coauthored the new ACOG guidelines. In this interview with Yahoo Life's Rachel Grumman Bender, Hofmann explains why IUDs can be painful for some, why any fears shouldn't scare people off from getting this highly effective contraceptive and how these pain management guidelines are an important step in the right direction. IUDs are really one of the most effective birth control methods out there. We call them LARCs, or long-acting reversible contraceptives. Hormonal IUDs are over 99% effective at preventing pregnancy, and nonhormonal IUDs are equally effective. What's nice about hormonal IUDs is that we also use them to manage a lot of gynecologic conditions, such as heavy menstrual bleeding and painful periods. However, patients are coming to us and saying, 'I do not want to have this horrible experience with getting an IUD. How can we manage this?' I've been in practice for a little over 20 years and [when I started out], we would tell people to take some ibuprofen beforehand and try to do some distraction techniques while we're putting it in. There's a lot of grin and bear it in gynecology and in women's health. It's really challenging for us as providers to give people an accurate assessment of what they're going to experience with IUD placement. I've seen people who have had IUDs placed where it was like, That was not terrible, and then all the way to That was the worst pain that I've ever had in my entire life and I had a natural childbirth. There's a very large range of how people experience pain as well as anxiety. So I think as a provider, the guidelines really put the onus on us to help people anticipate the pain and have that conversation about what they can expect. Sometimes they won't know until they're in the throes of it, and so it's about being prepared with some pain options in anticipation that it could be a really painful and uncomfortable procedure for them. IUD insertion requires the placement of a speculum, which sort of holds open the vagina in a way that's not normal. So having a speculum in the vagina is not really comfortable. Then there's the procedure itself. A lot of times, we have to manipulate the position of the uterus, and we do that sometimes by putting a clamp on the cervix. It's this sort of sharp instrument that takes a little 'bite' out of the cervix to hold it in place. So that tenaculum placement can be very painful. IUDs are placed in the uterus, which is a muscular organ. To do that, you have to go through the cervix, which is the opening to the uterus. The cervix can be very tight, especially if someone has not had a vaginal birth. And so getting through that cervical opening can be really painful for some. The uterine body itself has some nerves, so something going into the uterus is just crampy and painful — it's a very deep, visceral pain that is hard to explain to people if they've never had any kind of instrumentation in the uterus before. We also have a really large nerve called the vagus nerve that goes through the cervix; so people can also have this kind of vasovagal-type response when we manipulate the cervix, which makes people feel really terrible too. It makes you feel like you're going to pass out and you get hot and you feel like you're going to throw up. And sometimes people feel like they have to poop and that is a really uncomfortable feeling as well. So there are many different aspects that cause pain. But not everyone's going to feel that way. As a provider, I don't want to scare people out of getting this really effective birth control method or way to manage heavy menstrual bleeding. So [it's about] finding that balance between giving people the information they need so they can feel, OK, I'm going into this with my eyes open, but also not terrifying and scaring people away that they say, Yeah, I'm never ever gonna do that. I always say it's like going to a restaurant. You're going to tell 25 people when you have a terrible restaurant experience. But if you have a great restaurant experience or a mediocre restaurant experience, you don't really tell anybody. So, I think there's a lot of people who do great with their IUD insertion and really manage it well, but they're not as vocal about it as somebody who's had a really awful experience. What the evidence for the guidelines really demonstrated was that using some sort of topical lidocaine, which is a numbing agent, on the cervix was beneficial compared to a placebo or compared to other distracting techniques or ibuprofen and other pain medications. Many of us have been offering better pain management options in the last several years compared to maybe what was happening 10 or 25 years ago. We know from the evidence that anxiety tends to worsen pain. I think providers will give anxiolytics [medications to treat anxiety], so telling patients to take a little bit of Xanax or some Ativan to help with the anxiety. And I do think people are using localized lidocaine, whether that's in a gel or a spray or putting in an injectable lidocaine through a paracervical (nerve) block. I think that is becoming much more typical. There's also IV sedation. The other big thing that comes out of these guidelines is that we as providers owe it to our patients to have a discussion about some options that are available to them. So, it's really having the conversation, guiding patients to make the best decisions for themselves and then hopefully being able to find some interventions that you can do in your clinic safely and effectively to give people some options. I hope that these guidelines get the conversation started in a way that we're meeting people where their needs are ... that they feel heard and can access things like IUDs that are really highly effective ... and that we believe patients when they say, 'This was really painful.' Or, 'I had a really terrible experience last time I did this.' [We should] trust them to know their bodies and say, 'OK, here are the things we're going to do to hopefully try to improve that experience this time.' So I hope that's what comes out of it. Patients need to feel like they're in a space where they can advocate for themselves and be heard. This interview has been edited for length and clarity.
Yahoo
17-06-2025
- Health
- Yahoo
Too many women 'grin and bear it' when getting an IUD. I helped write new pain management guidelines to change that.
Millions of American women have had an IUD (a tiny T-shaped contraceptive device) inserted into their uterus. Many of them likely walked into their doctor's office with a bit of anxiety, not knowing what exactly the procedure would feel like: Would it be just a pinch or would it be incredibly painful? (There is no shortage of viral horror stories.) Also, would your doctor take your pain seriously? Up until recently, there wasn't a standard of care for IUD pain management. Women are often told to pop over-the-counter pain relievers before coming in for the procedure, even though they don't always control the pain. Any pain relief beyond that has been up to the woman's doctor or hospital, and depended on what options they had available. That's changing thanks to new guidelines on pain management for IUD placement issued by the American College of Obstetricians and Gynecologists last month, which follows the Centers for Disease Control and Prevention's updated guidelines in 2024. ACOG called out the 'urgent need' for doctors to acknowledge and treat patient pain and added that patients should 'have more autonomy over pain control options for their health care.' Genevieve Hofmann is a nurse practitioner who coauthored the new ACOG guidelines. In this interview with Yahoo Life's Rachel Grumman Bender, Hofmann explains why IUDs can be painful for some, why any fears shouldn't scare people off from getting this highly effective contraceptive and how these pain management guidelines are an important step in the right direction. IUDs are really one of the most effective birth control methods out there. We call them LARCs, or long-acting reversible contraceptives. Hormonal IUDs are over 99% effective at preventing pregnancy, and nonhormonal IUDs are equally effective. What's nice about hormonal IUDs is that we also use them to manage a lot of gynecologic conditions, such as heavy menstrual bleeding and painful periods. However, patients are coming to us and saying, 'I do not want to have this horrible experience with getting an IUD. How can we manage this?' I've been in practice for a little over 20 years and [when I started out], we would tell people to take some ibuprofen beforehand and try to do some distraction techniques while we're putting it in. There's a lot of grin and bear it in gynecology and in women's health. It's really challenging for us as providers to give people an accurate assessment of what they're going to experience with IUD placement. I've seen people who have had IUDs placed where it was like, That was not terrible, and then all the way to That was the worst pain that I've ever had in my entire life and I had a natural childbirth. There's a very large range of how people experience pain as well as anxiety. So I think as a provider, the guidelines really put the onus on us to help people anticipate the pain and have that conversation about what they can expect. Sometimes they won't know until they're in the throes of it, and so it's about being prepared with some pain options in anticipation that it could be a really painful and uncomfortable procedure for them. IUD insertion requires the placement of a speculum, which sort of holds open the vagina in a way that's not normal. So having a speculum in the vagina is not really comfortable. Then there's the procedure itself. A lot of times, we have to manipulate the position of the uterus, and we do that sometimes by putting a clamp on the cervix. It's this sort of sharp instrument that takes a little 'bite' out of the cervix to hold it in place. So that tenaculum placement can be very painful. IUDs are placed in the uterus, which is a muscular organ. To do that, you have to go through the cervix, which is the opening to the uterus. The cervix can be very tight, especially if someone has not had a vaginal birth. And so getting through that cervical opening can be really painful for some. The uterine body itself has some nerves, so something going into the uterus is just crampy and painful — it's a very deep, visceral pain that is hard to explain to people if they've never had any kind of instrumentation in the uterus before. We also have a really large nerve called the vagus nerve that goes through the cervix; so people can also have this kind of vasovagal-type response when we manipulate the cervix, which makes people feel really terrible too. It makes you feel like you're going to pass out and you get hot and you feel like you're going to throw up. And sometimes people feel like they have to poop and that is a really uncomfortable feeling as well. So there are many different aspects that cause pain. But not everyone's going to feel that way. As a provider, I don't want to scare people out of getting this really effective birth control method or way to manage heavy menstrual bleeding. So [it's about] finding that balance between giving people the information they need so they can feel, OK, I'm going into this with my eyes open, but also not terrifying and scaring people away that they say, Yeah, I'm never ever gonna do that. I always say it's like going to a restaurant. You're going to tell 25 people when you have a terrible restaurant experience. But if you have a great restaurant experience or a mediocre restaurant experience, you don't really tell anybody. So, I think there's a lot of people who do great with their IUD insertion and really manage it well, but they're not as vocal about it as somebody who's had a really awful experience. What the evidence for the guidelines really demonstrated was that using some sort of topical lidocaine, which is a numbing agent, on the cervix was beneficial compared to a placebo or compared to other distracting techniques or ibuprofen and other pain medications. Many of us have been offering better pain management options in the last several years compared to maybe what was happening 10 or 25 years ago. We know from the evidence that anxiety tends to worsen pain. I think providers will give anxiolytics [medications to treat anxiety], so telling patients to take a little bit of Xanax or some Ativan to help with the anxiety. And I do think people are using localized lidocaine, whether that's in a gel or a spray or putting in an injectable lidocaine through a paracervical (nerve) block. I think that is becoming much more typical. There's also IV sedation. The other big thing that comes out of these guidelines is that we as providers owe it to our patients to have a discussion about some options that are available to them. So, it's really having the conversation, guiding patients to make the best decisions for themselves and then hopefully being able to find some interventions that you can do in your clinic safely and effectively to give people some options. I hope that these guidelines get the conversation started in a way that we're meeting people where their needs are ... that they feel heard and can access things like IUDs that are really highly effective ... and that we believe patients when they say, 'This was really painful.' Or, 'I had a really terrible experience last time I did this.' [We should] trust them to know their bodies and say, 'OK, here are the things we're going to do to hopefully try to improve that experience this time.' So I hope that's what comes out of it. Patients need to feel like they're in a space where they can advocate for themselves and be heard. This interview has been edited for length and clarity.
Medscape
12-06-2025
- Health
- Medscape
VBAC Success Overestimated With Induction of Labor
MINNEAPOLIS — The vaginal birth after cesarean (VBAC) calculator may overestimate the likely success rate of a VBAC following induction of labor (IOL), according to research presented at American College of Obstetricians and Gynecologists (ACOG) 2025 Annual Meeting. The VBAC calculator does not distinguish between IOL and spontaneous labor, noted Daniel Lorido, MD, MPH, of Montefiore Medical Center in the Bronx, New York, and his colleagues. 'TOLAC [trial of labor after cesarean] patients who are undergoing IOL are significantly less likely to have a successful VBAC as compared to TOLAC patients undergoing spontaneous labor,' Lorido and his colleagues concluded. 'When offering indicated or elective inductions of labor, careful, individualized counseling on the likelihood of VBAC success is essential because a failed trial of labor after cesarean may cause increased perinatal morbidity when compared to successful VBAC or scheduled repeat cesarean delivery.' Noting that TOLAC IOL has higher rates of failure than spontaneous TOLAC, the authors sought to determine the success rate for TOLAC IOL and how it compares to spontaneous IOL and to the VBAC calculator's estimation of success for IOL. The researchers retrospectively analyzed all cases of patients who had a history of one prior cesarean and were undergoing an IOL between January 2020 and December 2023. All 270 patients had full-term, live-born, head-first, singleton births. Just over half the patients (51.1%) had a successful VBAC, but the VBAC calculator had predicted that 63.6% of patients would be successful ( P < .0001). The national rate of successful VBAC is 74.3%, the authors noted, but that includes both IOL and spontaneous labor. Factors associated with a successful VBAC include a history of prior vaginal delivery ( P = .0008), history of a prior VBAC ( P < .0001), and no history of arrest disorder ( P = .0007). Specifically, 72% of patients with a prior vaginal delivery had a successful VBAC after IOL compared to 46% of patients without a previous vaginal delivery. Similarly, 82% of patients with a previous VBAC had a successful VBAC after IOL compared to 43% of patients without a previous VBAC. Among the patients who had a successful VBAC, only 22% had a history of arrest disorder. The researchers did not find any associations between successful VBAC and age, BMI, chronic hypertension, or diabetes — even though age, weight, and treated chronic hypertension are all variables in the VBAC calculator score. Notably, the VBAC calculator was documented as a part of TOLAC counseling in only 11.39% of cases. 'In spite of these findings, we encourage offering TOLAC to all eligible patients while cautioning that accurate success rates be determined and communicated properly,' the authors wrote. 'TOLAC patients should be counseled about lower success rates of VBAC post-IOL to assist in their decision-making process.' It's important to keep in mind when considering these findings that they are all from a single center, Audrey Merriam, MD, MS, an associate professor of obstetrics, gynecology, and reproductive science at Yale School of Medicine, New Haven, Connecticut, told Medscape Medical News . 'There may be practice patterns or preferences at this one center that could impact these results,' Merriam said. She also noted that the study was moderately sized, which also adds caution to interpretation of the findings. That said, the study's key takeaway is that 'the VBAC calculator may not be as accurate when predicting TOLAC success for women who have had any prior cesarean delivery, not just a cesarean delivery for an arrest disorder,' Merriam said. 'The calculator is still just an estimate, so the decision to attempt a VBAC is still between the pregnant person and their physician/provider.' While the calculator provides one piece of information for patients and providers to consider when deciding whether to attempt a TOLAC, 'ultimately, the decision is a shared decision involving risks and benefits between the patient and provider,' Merriam said. The authors did not report receiving any external funding or having any disclosures. Merriam reported having consulted for Lily Link.
