Vaginal birth after previous C-section may be a safe option say doctors

By Dr. Ananya Mandal, MDJul 21 2010

According to new practice guidelines revealed for obstetricians by the American College of Obstetricians and Gynecologists this Wednesday, a vaginal birth after a Caesarean section (VBAC) or maybe even after two C-sections can be a safe and appropriate choice. A vaginal birth after C-section (VBAC) was a matter of debate due to various issues like hospital policies, assumed safety perception, legal issues, insurance matters and also doctor and patient convenience. The guidelines are published under ACOG's Practice Bulletin No. 115.

Dr. Richard N. Waldman, president of ACOG said, “Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals and insurers to swing the pendulum back to fewer caesareans and a more reasonable VBAC rate.” One of the authors of the new guidelines, Dr. Jeffrey Ecker, a maternal-fetal medicine specialist at Massachusetts General Hospital in Boston said, “These guidelines emphasize again that a trial of labor after Cesarean is an important option for most women.” Dr. William Grobman, another author and an associate professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine in Chicago echoed these thoughts. “Rather than provide a directive of 'you can' or 'you can't' do this, doctors need to provide information about the potential risks and successes and let women have autonomy to make their own decision,” he added.

This March a report was released by a National Institutes of Health advisory panel. It spoke of relieving some of the restrictions around VBAC. It concluded that all pregnant women should be offered this option and the risks and benefits associated with the procedure should be explained to them.

At present one-third of all U.S. births are by caesarean section. The rates of VBAC in 1996 were around 28.3%. The rates of VBAC have fallen to 8.5% in 2006. The ACOG says that about 60% to 80% of women who are appropriate candidates for a VBAC will be successful. The fear of rupture of the uterus during a VBAC was negated by the fact that it occurred in only 0.5% to 0.9% of cases. However there should be complete availability of emergency staff for emergencies like uterine rupture if VBAC is attempted.

According to the published guidelines likely candidates for VBAC included women with a previous C –section but it could also include;

• Women who have had two previous C-sections using a low transverse incision.
• Women who have had a C-section with a low transverse incision who are currently pregnant with twins.
• Women who have had a Cesarean delivery but do not know if they had a low transverse incision.