About
Birth
New ACOG
Guidelines: Vaginal Birth After Cesarean is a Safe Option
Press Release, July 27, 2010
Midwives
Alliance of North America
Geradine Simkins, President & Interim Executive Director
Washington, DC - The Midwives Alliance of North America
(MANA), a professional midwifery organization since 1982,
commends the American College of Obstetricians and
Gynecologists (ACOG) for their updated practice guidelines on
Vaginal Birth After Cesarean (VBAC) released July 21, 2010.
ACOG's recent guidelines are less restrictive than previous
ones. The new guidelines state that VBAC is a "safe and
appropriate choice" for most women who have had a prior
cesarean delivery, including some women who have had two
previous low-transverse cesarean incisions, women carrying
twins, and women with an unknown type of uterine scar.
There has been a dramatic increase in cesarean delivery in the
United States (from 5% in 1970 to nearly 32% in 2009) and a
rapid decrease of VBACs (from 28% in 1996 followed by a
decline to 8% in 2006). Lack of VBAC availability in U.S.
hospitals due to practitioner and institutional restrictions,
which diminished women's choices in childbirth, is often cited
as the reason for the conspicuous decrease in VBACs. In light
of the VBAC restrictions that have become commonplace in most
U.S. hospitals, it is noteworthy that ACOG's new guidelines
emphasize a woman's right to self-determination. The new ACOG
guidelines state that even if a hospital does not offer a
trial of labor after cesarean (TOLAC), a woman cannot be
forced to have a cesarean nor can she be denied care if she
refuses a repeat cesarean. In addition, previous ACOG
guidelines on VBAC stated that anesthesia and surgery must be
"immediately available" for an institution to offer VBAC; the
new guidelines have relaxed this restriction.
ACOG has seriously considered recommendations from the
National Institutes of Health (NIH) Consensus Development
Meeting on vaginal birth after cesarean held in Washington DC
in March 2010. Based on the scientific evidence, the NIH
expert panel affirmed that risks in VBACs are low, similar to
risks of other laboring women, and repeat cesareans expose
mothers and infants to serious problems both in the short and
long terms. The NIH expert panel concluded that in the absence
of a compelling medical reason, most women should be offered a
trial of labor after cesarean. The NIH expert panel further
recommended that all women be given unbiased educational
information during their pregnancies with which to make
decisions regarding VBAC in partnership with their healthcare
providers. Women should also be offered full informed consent
and refusal during their labors.
"While we are pleased that ACOG has issued less restrictive
VBAC guidelines and affirmed a woman's autonomy in her
childbirth experience, it is still up to women to take charge
of their lives, educate themselves about childbirth practices,
and put pressure on their healthcare practitioners to provide
the safest birth options for their babies and themselves,"says Geradine Simkins, President and Interim Executive
Director of the Midwives Alliance. The Midwives Alliance takes
the position that the best interests of most mothers and
infants are served when women are given the opportunity to
birth under their own power and in their own way with the
intention of avoiding primary cesarean deliveries and other
unnecessary interventions. An impressive body of research
literature shows that the midwifery model of care results in
less intervention in the birth process and safe and satisfying
outcomes for mothers and babies. In addition, evidence shows
that birth in a woman's home with a trained midwife, or in a
freestanding birth center, results in decreased cesarean
sections and other obstetrical interventions. "We want women
to have all the choices they need to have healthy pregnancies
and give birth safely," say Simkins, "and we are pleased that
ACOG's new guidelines on VBAC will add another choice to the
menu of maternity care options."
View the
"Ob-Gyns Issue Less Restrictive VBAC Guidelines"
here
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