ACOG revises guidelines on Vaginal Births after Cesarean Section (VBAC)

The American College of Obstetricians and Gynecologists, the nation’s leading professional group of women’s care providers, changed its ten-year-old guidelines regarding Vaginal Births After Cesareans (VBACs) this week. The 1999 guidelines stated that VBAC should be only be provided in institutions where physicians were “immediately available” should an emergency occur.

These emergencies occur in a minority (20%-40%) of attempted VBACs. Uterine rupture, the most severe and life-threatening emergency, occurs in only 0.5%-0.9% of cases. Overall, if VBAC is not successful, it carries more complications than a repeat C-section. The old ACOG guidelines are based in this reasoning, leading many providers to deny clients who previously had C-sections the choice of delivering vaginally.

The problem with this approach is that mothers refused VBACs are scheduled for subsequent C-sections by default, which contributes to the ballooning rate of premature births, maternal deaths, and other complications caused by overuse of this surgery. If VBAC is successful—as 60%-80% of them are—it carries fewer risks than a repeat C-section.

In a press release issued July 21, ACOG’s president Dr. Waldman responded to the need for a more balanced approach to VBAC, observing, “Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC." ACOG’s new guidelines recommend that women planning VBACs in facilities where physicians are not immediately available should engage in detailed advance planning with their providers about how to handle an emergency should one arise.

Echoing the conclusions of the National Institute of Health’s March conference on VBAC (see http://www.orgasmicbirth.com/blog/lily?page=1), the decision to try a VBAC should be based on a balanced assessment of each individual mother’s chances of successfully delivering vaginally alongside the risks that complications might develop during her labor. The previous guidelines recommend that only women who had one previous low-transverse C-section (where the incision was made across the bottom of the abdomen) could safely attempt VBAC. The new guidelines expand VBAC candidates to include women who have had two low-transverse C-sections, women expecting twins, and women with an “unknown type of uterine scar.” If care providers take note, the U.S. C-section rate will decline and mothers and babies will benefit.

Have you attempted a VBAC? How did your provider prepare for emergency situations? How did these preparations impact your experience?

For more information, please see the press release, http://www.acog.org/from_home/publications/press_releases/nr07-21-10-1.cfm and the new guidelines, http://www.acog.org/from_home/publications/green_journal/PBListOfTitles.pdf