New Guidelines Released for Births Following C-Section

by Susan Brady

It’s not uncommon these days for women to schedule cesarean sections early in their pregnancy, making plans to avoid a vaginal birth. Whether it is because they had a previous C-section, are trying to avoid the pain of childbirth, or just want to schedule the birth as a convenience, many doctors accommodate the request.

Mothers who have already had a cesarean birth may not know that a natural, vaginal birth is still possible with other children post C-section. Part of the problem is that vaginal birth after cesarean (VBAC) practices have been banned at 821 hospitals across the country, a fact reported as recently as January of 2009, pushing more and more women into surgery-involved cesareans.

"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Richard N. Waldman, MD, president of ACOG. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."
Following forty years of rising cesarean rates, the American College of Obstetricians and Gynecologists yesterday released revised guidelines on VBACs (vaginal birth after cesarean), stating that “Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans.”


The National Center for Health Statistics reported that the rate of cesarean sections in the United States rose 2 percent in 2007 to a record-breaking 31 percent, affecting one in every three women having babies in America that might have been preventable. The president of International Cesarean Awareness Network (ICAN), Pam Udy, says that this number is not something we should be proud of, “Every pregnant woman in the U.S. should be alarmed by this rate,” Pam continues that C-sections are becoming problematic, “Half or more of cesareans are avoidable and over-using major surgery on otherwise healthy women and babies is taking a toll.”

The ACOG press release announcing the new guidelines stated: In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a trial of labor after cesarean.

In fact, approximately 60-80% of appropriate candidates who attempt VBAC will be successful. The recovery time postpartum is significantly reduced for VBAC births and there are also significant benefits from avoiding abdominal surgery altogether. Doctors following these new guidelines could help in lowering the cesarean rate and, in turn, bring down medical costs for births. While not the driving force behind recommending VBACs, the cost of a cesarean delivery is significantly higher than that of a traditional birth, due to the cost of the surgical suite and medical team, longer hospital stay, and increased follow-up visits to the doctor.

Healthday.com