Make us your home page
Instagram

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

New guidelines call for more vaginal births after repeat C-sections

WASHINGTON — Most women who've had a C-section, and many who've had two, should be allowed to try labor with their next baby, say new guidelines — a step toward reversing the "once a cesarean, always a cesarean" policies taking root in many hospitals.

Wednesday's announcement by the American College of Obstetricians and Gynecologists eases restrictions on who might avoid a repeat C-section, rewriting an old policy that critics have said is partly to blame for many pregnant women being denied the chance.

Fifteen years ago, nearly 3 in 10 women who had had a prior C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.

Last spring, a National Institutes of Health panel strongly urged steps to reverse that trend, saying a third of hospitals and half of doctors ban women from attempting what's called VBAC, for "vaginal birth after cesarean."

The new guidelines declare VBAC a safe and appropriate option for most women — now including those carrying twins or who've had two C-sections — and urge that they be given an unbiased look at the pros and cons so they can decide whether to try.

Women's choice is "what we want to come through loud and clear," said Dr. William Grobman of Northwestern University, co-author of the guidelines. "There are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making."

Overall, nearly a third of U.S. births are by cesarean, an all-time high. Cesareans can be lifesaving but they come with certain risks — and the more C-sections a woman has, the greater the risk in a next pregnancy of problems, some of them life-threatening, like placenta abnormalities or hemorrhage.

The main debate with VBAC: That the rigors of labor could cause the scar from the earlier surgery to rupture. There's less than a 1 percent chance of that happening, the ACOG guidelines say. Also, with most recently performed C-sections, that scar is located on a lower part of the uterus that's less stressed by contractions.

Of those who attempt VBAC, between 60 percent and 80 percent will deliver vaginally, the guidelines note. The rest will need a C-section after all, because of stalled labor or other factors. Success is more likely in women who go into labor naturally — although induction doesn't rule out an attempt — and less likely in women who are obese or are carrying large babies, they say.

Thus the balancing act that women and their doctors weigh: A successful VBAC is safer than a planned repeat C-section, especially for women who want additional children — but an emergency C-section can be riskier than a planned one.

Because of those rare uterine ruptures, the obstetricians' group has long recommended that only hospitals equipped for immediate emergency C-sections attempt VBACs. Many smaller or rural hospitals can't do that, and that recommendation plus high-dollar lawsuits have been blamed for some hospital VBAC bans.

"Restricting access was not the intention," the new guidelines say.

They say hospitals ill-equipped for immediate surgery should help women find care elsewhere, have a plan to manage uterine ruptures anyway, and not coerce a woman into a repeat C-section.

New guidelines call for more vaginal births after repeat C-sections 07/21/10 [Last modified: Wednesday, July 21, 2010 7:13pm]
Photo reprints | Article reprints

Copyright: For copyright information, please check with the distributor of this item, Associated Press.
    

Join the discussion: Click to view comments, add yours

Loading...
  1. Pasco tax roll shows increase, but so, too, are budget requests

    Local Government

    NEW PORT RICHEY — Pasco County's tax roll grew by more than 5 percent in 2016, but it's a figure that likely would require local government budget writers to trim proposed spending requests.

    OCTAVIO JONES   |   Times
New construction accounted for $693.5 million in taxable property values being added to the Pasco County tax rolls in 2016, according to preliminary estimates released by Property Appraiser Gary Joiner. Overall, the property tax roll grew more than 5 percent, according to the preliminary numbers.

  2. Tampa Bay Super Bowls: A brief history and some predictions for 2021

    Bucs

    At last, Tampa will host a Super Bowl again. It used to be that the Cigar City would host one a decade, but by the time February 2021 rolls around, it will have been 12 years since the epic showdown between the Steelers and Cardinals. Because it has been awhile, let's revisit those past Super Bowls while also peering …

    Santonio Holmes hauls in the game-winning touchdown in the Steelers' 27-23 Super Bowl XLIII victory over the Cardinals in 2009, the last time Tampa hosted a Super Bowl. [JAMES BORCHUCK | Times]
  3. Rays bats go silent in second straight loss to Angels (w/video)

    The Heater

    ST. PETERSBURG — Sure, Alex Cobb was to blame for the Rays' 4-0 loss on Tuesday.

    Derek Norris strikes out with the bases loaded as the Rays blow a golden opportunity in the seventh inning.
  4. Analysis: Manchester attack was exactly what many had long feared

    World

    LONDON — For Britain's security agencies, London always seemed like the likely target. For years, the capital of 8 million with hundreds of thousands of weekly tourists and dozens of transit hubs had prepared for and feared a major terror attack.

  5. Dade City man dies after crashing into county bus, troopers say

    Public Safety

    ZEPHYRHILLS — A 38-year-old man died Tuesday after colliding into the rear of a county bus on U.S. 301, the Florida Highway Patrol said.