ACOG Guidelines Call for More Vaginal Births After Cesarean

Recommending that women with two prior low-transverse cesareans be candidates for VBAC
By Lindsey Marcellin
HealthDay Reporter

THURSDAY, July 22 (HealthDay News) -- Vaginal birth after cesarean (VBAC) is a safe option for most women who have had one prior cesarean delivery and for some who have had two prior cesarean deliveries, according to new guidelines released by the American College of Obstetricians and Gynecologists and published in the August issue of Obstetrics & Gynecology.

Jeffrey L. Ecker, M.D., of the Massachusetts General Hospital in Boston, and William A. Grobman, M.D., of Northwestern University in Chicago, co-wrote the new guidelines reflecting concern about the high rate of cesarean births in the United States, which reached 31 percent in 2007. VBAC rates had been falling due to hospital and insurer restrictions on trial of labor after cesarean (TOLAC) and decisions by patients who were given risks and benefits.

The new guidelines emphasize the need for thoughtful and thorough counseling regarding the risks and benefits of both VBAC and repeat cesarean delivery. Most women with one prior cesarean with a low-transverse incision are candidates for VBAC, as in prior guidelines. The new guidelines also say that women with two prior low-transverse cesarean incisions, as well as women carrying twins and those with an unknown type of uterine scar, may be given the option of TOLAC.

According to the guidelines, "a trial of labor after previous cesarean delivery should be undertaken at facilities capable of emergency deliveries. Because of the risks associated with TOLAC, and that uterine rupture and other complications may be unpredictable, the College recommends that TOLAC be undertaken in facilities with staff immediately available to provide emergency care."

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