ICAN of Monterey County

Subtitle

VBAC

If you live in Monterey County and are interested in learning more about your options concerning VBAC, please contact us so we may assist you!  You CAN VBAC!


In 2010, the National Institutes of Health (NIH) reaffirmed the same information they had shared at their landmark 1980 summit on VBAC and shared that yes, VBAC labors have a very high rate of success for most women.  


NIH VBAC Consensus Statement

In 2010, the American Congress of Obstetricians and Gynecologists (ACOG) released updated practice guidelines for vaginal birth after cesarean (VBAC).   ICAN hopes ACOG’s new VBAC guidelines will enable women to find the support and evidence-based care that they need and deserve. Every woman must understand the capabilities and limitations of the care provider and facility she chooses. Less restrictive access to VBAC will lead to lower risks to mothers and babies from accumulating cesareans. The updated guidelines state that VBAC is a safe and reasonable option for most women, including some women with multiple previous cesareans, twins, and unknown uterine scars. ACOG also states that respect for patient autonomy requires that even if an institution does not offer trial of labor after cesarean (TOLAC), a cesarean cannot be forced nor can care be denied if a woman declines a repeat cesarean during labor.


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Ob Gyns Issue Less Restrictive VBAC Guidelines 

July 21, 2010

Washington, DC -- 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, according to guidelines released today by The American College of Obstetricians and Gynecologists.


The cesarean delivery rate in the US increased dramatically over the past four decades, from 5% in 1970 to over 31% in 2007. Before 1970, the standard practice was to perform a repeat cesarean after a prior cesarean birth. During the 1970s, as women achieved successful VBACs, it became viewed as a reasonable option for some women. Over time, the VBAC rate increased from just over 5% in 1985 to 28% by 1996, but then began a steady decline. By 2006, the VBAC rate fell to 8.5%, a decrease that reflects the restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC) as well as decisions by patients when presented with the risks and benefits.


"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."


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 TOLAC. In addition, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.


VBAC Counseling on Benefits and Risks

"In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor, all viewed in the context of her future reproductive plans," said Dr. Ecker. Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).

Both repeat cesarean and a TOLAC carry risks including maternal hemorrhage, infection, operative injury, blood clots, hysterectomy, and death. Most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has fewer complications than an elective repeat cesarean while a failed TOLAC has more complications than an elective repeat cesarean.


Practice Bulletin #115, "Vaginal Birth after Previous Cesarean Delivery," is published in the August 2010 issue of Obstetrics & Gynecology.

http://www.acog.org/Resources_And_Publications/Practice_Bulletins/Committee_on_Practice_Bulletins_--_Obstetrics/Vaginal_Birth_After_Previous_Cesarean_Delivery


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Harvard Magazine
"Labor Interrupted:  Cesareans, 'cascading interventions,' and finding a sense of balance"
http://harvardmagazine.com/2012/11/labor-interrupted

"15 percent rate, WHO reasoned, would optimally prevent childbirth injuries and deaths, but many women and babies would avoid unnecessary and potentially harmful surgery. WHO has since modified this specific recommendation, stating in 2009 that “the optimum rate is unknown,” but that “both very low and very high rates of cesarean section can be dangerous.” 

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American Congress of Obstetricians and Gynecologists
ACOG Today, August 2010
http://www.acog.org/~/media/ACOG%20Today/acogToday0810.pdf?dmc=1&ts=20130519T2238220943

"During his inaugural address at the Annual Clinical Meeting (ACM) in May (2010), ACOG President Richard N. Waldman, MD, said a new sense of urgency must be placed on reducing the rate of cesarean deliveries and asked Fellows to 'recommit to do everything in our power to reduce the cesarean rate.'"  "The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," Dr. Waldman said.  "Moving forward, we need to work 
collaboratively with our patients, our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate.'"

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NY Times
New Guidelines Seek to Reduce Repeat Cesareans
July 21, 2010
http://www.nytimes.com/2010/07/22/health/22birth.html?_r=0

"It will be better for women in the long run if we can lower the C-section rate,” said Dr. Richard N. Waldman, president of the obstetricians’ group and chairman of obstetrics at St Joseph’s Hospital in Syracuse.