New guidelines out from the American College of Obstetricians and Gynecologists are out to reverse the old expression ‘once a cesarean, always a cesarean. The group is now saying that “most women who have had a c-section, and many of them who have had more than one, should be allowed to try labor with their next birth.”
“In recent years hospitals, doctors and insurers have been refusing to let them even try, insisting on repeat Caesareans instead,” the New York Times reported on its front page. The “decisions have been based largely on fears of medical risks and lawsuits, medical and legal experts say.”
This, in turn, has “infuriated many women, added to the nation’s ever-increasing Caesarean rate and set off a bitter debate over who controls childbirth.”
The “OB-GYN group has acknowledged that one word in its 1999 and 2004 VBAC guidelines is partly to blame,” USA Today reported. “Previously, the group had recommended that only hospitals with a ‘readily available’ surgical team – interpreted as no more than a half-hour drive away – allow VBACs.”
Then, the “1999 guidelines called for an ‘immediately available’ surgical team,” which many hospitals “interpreted … as needing to have an anesthesiologist and operating room standing by whenever a patient attempts a VBAC. If they can’t meet the guidelines, they argue, they’re opening themselves up to lawsuits should mother or baby be injured during a VBAC attempt.”
Important to note is that “there’s less than a one percent chance” that the “scar from the earlier surgery” would rupture, the AP reported. What’s more, “with most recently performed C-sections, that scar is located on a lower part of the uterus that’s less stressed by contractions.”
In fact, “of those who attempt VBAC, between 60 percent and 80 percent will deliver vaginally, the guidelines note,” but the “rest will need a C-section … because of stalled labor or other factors.”
“‘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,’ Dr. Richard N. Waldman, president of ACOG, said in a news release,” according to the Los Angeles Times (7/21, Roan) “Booster Shots” blog.
Notably, the “guidelines follow the release in March of a report from a National Institutes of Health advisory panel calling for an easing of restrictions surrounding VBAC.” The NIH “report combined with ACOG’s new guidelines have the potential to usher in a new era of childbirth in the United States, returning it to a more natural, less-invasive event.”