On Tuesday this week, the American College of Obstetricians and Gynecologists (ACOG), which is the organization responsible for producing practice guidelines for obstetricians and gynecologists, released new guidance that aims to make VBAC (vaginal birth after cesarean) available to anyone who wants to have one. These new guidelines are released as the United States currently experiences a too-high c-section rate (1 in 3 people) and a too-low VBAC rate of 10%, and simultaneously, we have one of the highest maternal mortality rates! Many families who want to attempt VBAC find that there is no hospital in their area that allows VBAC, or few or no practices with obstetricians who will support VBAC.
In their release, ACOG states: "Vaginal birth after cesarean delivery (VBAC) should be attempted at maternal care facilities that typically manage uncomplicated births if they are capable of performing emergency deliveries."
When addressing the "why" VBAC is so infrequently performed and supported, ACOG believes it is due to a misunderstanding of the safety of VBAC and fear of medical liability on the part of obstetricians. However, 60-80% of women who attempt trial of labor after cesarean delivery (TOLAC) are successful in achieving vaginal birth. Why does this matter? Why is VBAC important? According to ACOG:
VBAC allows women to avoid major abdominal surgery and lowers their risk of hemorrhage, blood clots and infection. It also shortens the recovery period and reduces women’s risk of experiencing maternal morbidity or mortality during delivery in a future pregnancy due to repeated C-sections.
By increasing access to VBAC, we increase the likelihood of improved, safer, and healthier outcomes for moms and babies. ACOG's new guidelines go up against hospitals that have "no VBAC" policies. Even level I hospital facilities that manage low-risk births should allow and support VBAC, as long as an obstetrician who can perform emergency c-section is present.
ACOG cautions that the decision to have TOLAC and VBAC is a personal and unique one to each individual: "The best circumstance for a woman to labor after having had a prior C-section is when the balance of risks and chances of success are acceptable to both the patient and the physician, and that will be different in every case."
Good News & Bad News
The revised ACOG guidelines are a step in the right direction! That said, it can take many years before practices and hospitals get on board with guidelines. New guidelines do not mean that a level I hospital that meets the requirements will start supporting VBAC next week. If you are pregnant and seeking VBAC, your best bet at the current time is to do your research to find a practice, obstetrician, and hospital that truly supports VBAC. Start by connecting with your local ICAN (International Cesarean Action Network) to talk with professionals and other VBAC families in your area. They will be an indispensable resource to you in finding the most supportive care providers.