Updated recommendations for women's health have been released online by the American College of Obstetricians and Gynecologists (ACOG; http://www.acog.org), as summarized here:
* Long-acting reversible contraceptives (LARCs), which include intrauterine devices (IUDs) and contraceptive implants, provide the benefits of effective contraception without user effort once the device is placed as well as immediate return of fertility after device removal. Increasing the use of LARCs can contribute to decreases in unintended pregnancies and rates of abortion. LARC usage rates are lower in adolescents than in other age groups. ACOG recommends that both IUDs and implants be offered to women who haven't had children yet, including teenagers, because complications of these methods are uncommon. Either device can be inserted immediately after induced or spontaneous abortion, or after vaginal or cesarean delivery.
* Vaginal seeding is the process of inoculating a cotton gauze or swab with vaginal fluids to transfer vaginal flora to a newborn infant's mouth, nose, or skin following cesarean delivery. Its purpose is to promote gut colonization in infants not delivered vaginally. Transfer of bacteria during vaginal birth is believed to stimulate infant immune function and reduce the risk of allergic disorders. Notably, rates of asthma, atopic disease, and other immune disorders have increased in tandem with rates of cesarean delivery. ACOG recommends that vaginal seeding be done only as part of an approved research protocol; a clinical trial is currently under way. A patient who wishes to perform vaginal seeding herself should be advised of the potential risk of transferring pathogenic organisms to her newborn.
* Vaginal birth after cesarean (VBAC) delivery provides many health advantages to mothers. A VBAC also decreases the population-wide rate of cesarean deliveries-now representing nearly a third of U.S. births. However, a trial of labor after cesarean (TOLAC) delivery that does not lead to vaginal birth and instead results in repeat cesarean delivery yields more complications for mother and newborn than planned cesarean delivery. ACOG has provided recommendations for identifying obstetric patients who are likely to achieve VBAC as some clinical characteristics reduce the likelihood. A TOLAC may be offered to most women with one or two prior cesarean deliveries via low-transverse uterine incision, which is associated with reduced risk of uterine rupture, and to those whose first cesarean delivery was performed for a nonrecurring reason such as breech presentation.-Joan Zolot, PA