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 American College of Obstetricians and Gynecologists (ACOG) actively supported VBAC, and physicans were strongly encouraged to counsel and encourage women to plan a trial of labor, rather than schedule a surgery. See ACOG’s 1995 guidelines.

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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