Vaginal Birth After Cesarean
A woman who has had a
cesarean delivery with a previous birth has a choice to make for subsequent
deliveries: she might choose a repeat cesarean, or she might choose to plan for
a VBAC, vaginal birth after cesarean.
For many years, the
In 1999, the guidelines
changed. (For a criticism of
ACOG’s stance, see Marsden
Wagner’s article). They recommended that for VBAC births, a
physician must be “immediately available throughout active
labor capable of monitoring labor and performing an emergency cesarean
delivery,” and there must be “Availability of anesthesia and personnel for
emergency cesarean delivery.” The cost and inconvenience of these
recommendations led some hospital caregivers to begin re-examining their VBAC
protocols. (It is
likely that practice recommendations are also influenced by lawsuits and by
pressure from insurance companies to minimize potential lawsuits. Here is a
comment on VBAC’s from one insurance
company.)
Then, in July of 2001,
the New England Journal of Medicine published a study (Lydon-Rochelle
et al) and an accompanying editorial by Michael Greene focused on the potential
risk of uterine rupture with VBAC, or especially with an induced VBAC labor.
(For criticism of these articles, and of the media coverage of them, see “Fighting
VBAC-lash. Critiquing Current Research” and “Is
Vaginal Birth After Cesarean Risky”)
With all of these influences, some hospitals and some caregivers are changing their care recommendations for women with prior cesarean. Some are choosing to no longer offer the option of VBAC to their patients.
Many birth
professionals have questioned the ACOG guidelines, questioned the study, and
questioned care providers who withhold the option of vaginal birth for women
after cesarean. They argue that VBAC is still the safest option for women with
a prior cesarean. For some of these statements, see http://www.vbac.com/hottopic/highestrate.html. There are also several excellent articles about
VBAC on Mothering magazine’s website, and on www.ican-online.org
For care providers in
the Seattle area who support the VBAC option, click here.
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