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New VBAC Guidelines: Information and Choice for Women

New VBAC Guidelines: Information and Choice for Women

Restrictive policies regarding vaginal delivery after a cesarean (VBAC) should not be used to force women to undergo a repeat cesarean delivery against their will.

The new guidelines from the American College of Obstetricians and Gynecologists (ACOG) say that VBAC is a safe choice for most women with a low-transverse incision.

The rate of cesarean sections is very high in many industrialized countries, causing unnecessary risk to both mother and baby.

In the U.S., cesareans have increased from five percent in 1970 to more than 31 percent by 2007. Prior to 1970, it was standard practice to perform repeat cesareans, but success during the 70s made it a viable option for some women. The VBAC rate grew over the years to 28 percent by 1996. After that, defensive medicine took hold, with increased restrictions by hospitals and insurers causing the VBAC rate to begin falling again.

The ACOG’s guidelines come as welcome news to many women. VBACS are successful 60 – 80 percent of the time, helping women to avoid major abdominal surgery, risk of hemorrhage and infection, and resulting in a shorter recovery time.

Richard N. Waldman, MD, president of ACOG, said, “Given the onerous medical liability climate for ob-gyns, interpretation of The College’s earlier guidelines led many hospitals to refuse allowing VBACs altogether. Our primary goal is to promote the safest environment for labor and delivery, not to restrict women’s access to VBAC.”

“It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance,” said Dr. Grobman, of Northwestern University in Chicago, who co-wrote the guidelines.

In March, a National Institutes of Health advisory panel also concluded that women should be fully informed of their options, the risks and the benefits, and allowed to make their own choice.

The non-profit International Cesarean Awareness Network (ICAN) responded to the ACOG’s new guidelines, saying, “ACOG’s updated recommendations for VBAC are much more in line with the published medical research and echo what ICAN has said for years. The benefits of VBAC cannot be overstated and if ACOG is truly ‘serving as a strong advocate for quality health care for women’ then this is a long overdue action on their part.”

ICAN hopes ACOG’s new VBAC guidelines will enable women to find the support and evidence-based care that they need and deserve. Every woman must understand the capabilities and limitations of the care provider and facility she chooses. Less restrictive access to VBAC will lead to lower risks to mothers and babies from accumulating cesareans.

Women should have the information they need to make decisions about their medical care. That’s a given. Why that should ever be in question is mind-boggling. But whether physicians, hospitals, and medical insurers go along with the guidelines is another matter.

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48 comments

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7:02AM PDT on Aug 3, 2010

Unless insurance companies think there will be less cost the odds of a doctor going with patient preference is low. Health care needs to be made available through a public option so best practices are given a fair shake.
I hope the rate of c sections goes down but all my neices and nephews were born that way and I doubt the medical community will change it's mind without a big push from hospitals and insurance carriers.

5:56AM PDT on Aug 3, 2010

Anything that would make it easier for women to give birth, should be welcomed.
We men, have a fleeting satisfaction but women have to walk with the consequences for 9 months and then give painful birth!
Sorry, girls!

10:28AM PDT on Jul 28, 2010

thanks

4:56AM PDT on Jul 28, 2010

Heya, I have four children. My first baby girl was born by Emergency Caesarian Section.As I had no previous experience I did everything the Staff at hospital told me. I had a terrible time and had every sort of test done during labour, was monitored throughout the duration,,so I couldn't move at will.I had my feet in stirrups,scalp samples of the baby's head etc! Whilst I was on Pethidine I signed permission to have a C-section. The next thing I was being told to get on the table at theatre. She was born healthy although a little under weight(probably because I'd been told not to eat anthing prior to being admited to the labour ward) I didn't get to hold her for about twenty minutes after the operation but luckily she was waiting patiently for her first feed and was fine.Then I went on to have my other three children at home with no problems.My first son was a week overdue. My second Daughter was three weeks overdue and my last child was only four hours overdue.I was strongly advised not to have a home birth but It is not the decision of anybody else apart from the Mum who is about to give birth and I felt more comfortable at home in my own surroundings. Being relaxed helps with Labour anyway and actually can be quite pleasant.I had my last child in a different county and the midwives didn't even bring me any gas and air so I've experienced a complete natural birth.I was born at home myself ; )

11:47PM PDT on Jul 27, 2010

thanks

1:44PM PDT on Jul 27, 2010

I agree Martha

8:40PM PDT on Jul 26, 2010

I'd suggest thoroughly exploring and reading up on the methods that can be used to deliver your child well in advance so that you will be the most informed on what method you'd like. Never rely solely on the advice from a doctor since their advice may not be impartial. The information you find on the internet or at your local library would be more beneficial. Then once you do decide on your method of choice, be sure to let your doctor know what you want. If there is any disagreement about what you want, then you'll still have time to find another doctor before the delivery. It is your body and your baby. No one should be able to decide how you want to deliver your child.

3:27PM PDT on Jul 26, 2010

thks for info

12:04PM PDT on Jul 26, 2010

thankyou for shareing

11:48AM PDT on Jul 26, 2010

Birthing options decisions should be made based upon the best health and welfare of the mother and her infant. Too often a C-section is a matter of convenience both for the MD and the parents. It has its inherent risks and is not a walk in the park. Thankfully there are ways to ease the pain of labor and delivery so that pain should not be a deciding factor.

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