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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