New guidelines say vaginal birth OK after c-section

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Even if they aren't staffed to handle emergency cesarean sections, hospitals should respect a woman's informed choice to have a vaginal birth after cesarean (VBAC), new guidelines say.

VBAC is known to increase the risk that the scar left in the womb from a previous cesarean will tear during labor, leading to massive bleeding that can threaten the baby's life. That has led to previous guidelines urging caution for women who have had cesarean sections.

But recent research shows so-called uterine rupture occurs in less than one percent of women who opt for vaginal birth, and that between 60 and 80 percent of VBACs are completed successfully.

While the new guidelines from the American College of Obstetricians and Gynecologists (ACOG) still say a full surgical team should be present in case an emergency cesarean is required, they now put a bigger emphasis on the woman's decision.

"Respect for patient autonomy supports that patients should be allowed to accept increased levels of risk; however, patients should be clearly informed of such potential increase in risk and management alternatives," they say.

"For most women with a previous cesarean delivery, a trial of labor is a safe and appropriate option," ...

... Even women who've had two prior cesareans might be good candidates for vaginal birth ...

... Today, about nine in 10 pregnant women ... end up with a repeat cesarean if they've already had one. By comparison about a third of all women who give birth have cesareans.

"... the cesarean rates are going up too fast," ... "There is no good evidence that newborns are better off now than they were 20 years ago."...

Melissa Maimann, Essential Birth Consulting 0400 418 448