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New Guidelines Declare Attempted VBAC Safe Choice for Most Women

Kingston Personal Injury Attorney

The American College of Obstetrics and Gynecologists has issued new guidelines declaring attempted vaginal birth after cesarean (VBAC) to be a safe choice for most women who have had a prior cesarean delivery, and even for some women who have had two previous cesareans. APP.com states that medical research shows C-sections are absolutely necessary in about 15 percent of cases; yet the cesarean delivery rate in the United States was over 31 percent in 2007, according to a recent press release issued by the American Congress of Obstetrics and Gynecology (ACOG).

Between 1985 and 1996, the nation saw the rate of VBAC rise from five percent to 28 percent; however, since then, the rate has fallen to 8.5 percent in 2006. ACOG partially attributes the decrease to the restrictions that some hospitals and insurers have placed on trial of labor after cesarean (TOLAC). Dr. Richard N. Waldman, president of the College, said the current rate of C-section deliveries “is undeniably high and absolutely concerns us as ob-gyns.”

Successful VBAC

According to ACOG, 60-80 percent of appropriate candidates who attempt VBAC will be successful, offering the following benefits to the mother:

  • Avoidance of major abdominal surgery
  • Reduced risk of hemorrhage and infection
  • Shortened postpartum recovery
  • Potential avoidance of future complications from having multiple cesareans, such as hysterectomy, bowel and bladder injury, transfusion, infection and abnormal placenta conditions

Uterine Rupture

ACOG states that the risk of uterine rupture during TOLAC is low, between 0.5 and 0.9 percent. But rupture is an emergency situation that can cause serious injury to the mother and baby. TOLAC is most safe when done with health care staff that can immediately provide an emergency cesarean. ACOG explains that a successful VBAC has fewer complications than an elective repeat cesarean.

Safe Delivery Options

According to Medical News Today, the new guidelines are couched in more optimistic terms. The 2004 version warned that although VBAC was appropriate for most women who have had a low-transverse cesarean, “several factors increase the likelihood of a failed trial of labor, which in turn leads to increased maternal and perinatal morbidity.” Instead, the new guidelines state that TOLAC “provides women who desire a vaginal delivery with the possibility of achieving that goal.”

Dr. Waldman explained that, due to the “onerous medical liability climate for ob-gyns, interpretation of The College’s earlier guidelines led many hospitals to refuse allowing VBACs altogether.” It remains to be seen whether the new guidelines will create an equally disproportionate reaction as practitioners seek to reduce cesarean delivery rates. Mothers or newborns who have suffered from birth injuries or other medical negligence in delivery should contact a personal injury attorney to discuss their options.