Thinking about having a VBAC (vaginal birth after cesarean?). Then you should be happy to learn that the American College of Obstetricians and Gynecologists (ACOG) issued new, less restrictive VBAC guidelines today. You can read a New York Times story about the change here.
From today’s press release:
Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans…
“The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns,” said Richard N. Waldman, MD, president of The College. “These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate.”
Previous recommendations were that most women with one previous C-section delivery with a low-transverse incision should discuss VBAC options with their care providers, and be offered a trial of labor. New guidelines add that women with TWO previous low-transverse C-section incisions, women carrying twins AND women with an unknown type of uterine scar should also be considered as candidates for a trial of labor after cesarean.
Interpretations of ACOG’s previous VBAC guidelines also led some hospitals to refuse trial of labor and VBACs entirely. The reformed guidelines state:
“…hospitals that lack ‘immediately available’ staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur.”
While risks of a VBAC include uterine rupture, the risk is low: less than 1 percent. One of the most obvious benefits of a VBAC is avoiding major abdominal surgery; it also lowers a woman’s risk of hemorrhage and infection, and shortens postpartum recovery.
To read more from ACOG, click here. To find information on local hospitals’ VBAC policies (before the new ACOG guidelines), see the International Cesarean Awareness Network’s list (scroll down until you see Minnesota hospitals).
Alisa, Sarah & the women of Blooma