July 22, 2010

Vaginal Birth After C-Section OK, New Guidelines Say

Doctors and hospital staff should allow a woman to undergo a vaginal birth, even if she previously had undergone a cesarean section, according to new guidelines set forth by the American College of Obstetricians and Gynecologists (ACOG) on Wednesday.

It is believed that having a vaginal birth after cesarean (VBAC) increases the risk that a scar left behind by a previous cesarean delivery could tear, causing massive bleeding and endangering the baby's life. However, according to Frederik Joelving of Reuters, "recent research shows so-called uterine rupture occurs in less than one percent of women who opt for vaginal birth, and that between 60 and 80 percent of VBACs are completed successfully."

Still, ACOG officials encourage that a full surgical team be on-hand in case of emergency.

The mother's choice is "what we want to come through loud and clear," Dr. William Grobman of Northwestern University, the co-author of the guidelines, told Lauran Neergaard of the Associated Press on Wednesday. "There are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making."

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," ACOG President Dr. Richard N. Waldman said in a July 21 press release. "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."

"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," he added. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."

According to Joelving, approximately one out of every three births in the U.S. are cesareans, and 90-percent of all pregnant women who have already undergone a C-section undergo a second.


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