New guidelines give C-section moms a choice of vaginal delivery

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Recent changes in national guidelines are prompting more women with C-section scars to choose to try to birth subsequent children vaginally, and more providers willing to offer the choice ...

"I think we've seen the bottom of the pendulum with the VBAC rate, and it will swing the other way," said Dr. George Macones, an expert in the safety of a vaginal birth after Caesarean.

... Despite research that estimates 60 percent to 80 percent of women with prior C-sections would succeed in attempting a vaginal birth, the latest figures show the rate has fallen to just 8 percent from 28 percent in 1996.

While the conference will cover issues such as caring for a Caesarean scar, legislative advocacy and delivering breech babies, the weekend will focus on educating women and health-care professionals about the latest evidence regarding vaginal births after Caesareans ...

A year ago, the National Institutes of Health gathered evidence from experts in multiple health fields and concluded that labor is a "reasonable option" for women with prior C-sections.

Shortly after, the American College of Obstetricians and Gynecologists loosened its guidelines stating that attempting a vaginal birth after Caesarean is a 'safe and appropriate choice" for women, including those carrying twins, with two previous Caesareans, a suspected large baby or gestation beyond 40 weeks.

Macones ... has published more than two dozen studies about the safety. He has reviewed records of almost 25,000 women at multiple hospitals and found that the risk of uterine rupture ... is less than 1 percent.

"VBAC is not as dangerous as it has been painted to be," ... Several other obstetric procedures carry the same, if not higher, complication rates.

... the "perfect storm" led to the marked decrease in the VBAC rate: physicians' more aggressive use of medications to induce or speed up labor ... , the rising cost of malpractice insurance and patient preference.

In addition, the obstetrician college released guidelines in 1999 that recommended a surgical staff be "immediately available" when a woman with a prior Caesarean is attempting a vaginal birth. This led many hospitals, insurers and physicians to refuse services to women wanting to avoid another C-section.

... various surveys show approximately one-third of hospitals and one-half of physicians no longer offer trial of labor to women with Caesarean scars.

The obstetrician college's latest revision still maintains that attempting a VBAC is safest with immediate access to an emergency Caesarean but recognizes these resources aren't always available ...

The new guidelines state that vaginal birth after Caesarean is associated with decreased maternal morbidity and risks of complications in future pregnancies. A failed attempt, however, carries higher risks, making it important for doctors to assess which women are likely to be successful.

Some women's health and professional organizations ... feel the changes did not go far enough in providing a birthing choice to women with prior C-sections. Despite the low risk of uterine rupture, many providers and hospitals ... still have restrictions because of the recommendation a surgical staff be on hand ...