Guidelines relax stance on vaginal birth after cesarean - - ModernMedicine

Guidelines relax stance on vaginal birth after cesarean
Publish date: Aug 1, 2010
Source: Contemporary OB/GYN

New guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) are less restrictive about attempting vaginal birth after cesarean delivery (VBAC), reflecting concern about the soaring rate of cesarean deliveries in the United States.

The revised guidelines, released on July 21, emphasize the need for thorough counseling, shared decision-making, and patient autonomy, according to ACOG President Richard N Waldman, MD.

Previous guidelines suggested that most women with 1 previous cesarean delivery with a low-transverse incision are candidates for, and should be counseled about, VBAC and be offered a trial of labor before converting to cesarean delivery. The recommendations now include women who have had 2 previous cesarean deliveries, who are carrying twins, and those with an unknown type of uterine scar.

Risk of uterine rupture during trial of labor after cesarean (TOLAC) is 0.5% to 0.9%. ACOG recommends that TOLAC be attempted when staff can immediately convert to cesarean delivery. Women and their ob/gyns are advised to consider TOLAC in the context of potential risk, available resources, and the healthcare system.

The bulletin on the revised guidelines is available on the ACOG Web site ( http://www.acog.org).

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Comments from our Readers
hackmeyer / los angeles, CA, UNITED STATES
 Posted 2010-08-09 00:45:44.0
In counseling patients to attempt a VBAC after 2 previous C-Sections across the board is fraught with hazard. Recently, I counseled a patient to not attempt a VBAC, because her first labor resulted in a C-Section for failure to descend, Her second delivery was a failed VBAC for failure to descend and attempting a VBAC a second time seemed all risk and no benefit.
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Source: Contemporary OB/GYN, 8/1/2010
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