Posts Tagged ‘new guidelines’

August 3rd, 2010

New VBAC Guidelines

After being so involved in the National Institute of Health’s VBAC consensus earlier in the year, I, as well as so many others were really anticipating the new ACOG VBAC Guidelines. The decline in VBAC began when they changed their guidelines suggesting only certain women, and certain hospitals were candidates for a Trial of Labor after a previous Cesarean delivery.  We saw a peak in the VBAC numbers in 1996, then a drop consistently there after.

ACOG included in their release something new that previously had been unthinkable in the medical community as a valid option for most women, and that is a trail of labor after two previous cesarean sections. Studies show that it is a safe and valid option for women who wish to attempt a VBA2C, which I have been saying all along.  But maybe now because a huge medical organization with MD after their names says it, people will understand it truly is a safe choice for mothers to make.

Also included in these guidelines are women pregnant with twins, with a prior cesarean delivery, and an unknown uterine scar, which in the past have meant automatic repeat cesarean deliveries.

Just some numbers to include into this also.

In 1970, the cesarean delivery rate was 5%, in 2007 it increased to over 31% of all deliveries with very little improvement to maternal and neonatal outcomes. VBAC was at about 5% which increased all the way up to 28% in 1996. Then the decline started, in 2006 the VBAC rate dropped down to a little over 8%.  Which is horrible for our women here in the U.S.

While I stand by women being informed on making their own choices regarding their care, as a mother who has had two cesarean deliveries, researched, learned the numbers, the risks, and everything involved in VBAC vs. ERCD (Elective Repeat Cesarean Delivery) the risks for a repeat c-section are much higher than a trial of labor after a previous cesarean. You are more likely to have long term complications, be re-hospitalized, need a type of blood product, and all the risks that go along with major surgery when opting for a cesarean over a trial of labor.

The risk for a uterine rupture is between 0.6-0.8% with one previous cesarean delivery, and the most recent studies and numbers has not shown a neonatal death from uterine rupture. I am not sure the amount of years it has been, but per the information from the NIH VBAC consensus, it has been at least 10 years since they have documented a case.

Maternal mortality rates are higher with elective repeat cesarean deliveries over VBAC also. When comparing ERCD to VBAC, per 100,000 births, there are 9 less maternal deaths with VBAC than elective repeat cesarean delivery. Hence showing that VBAC is safer, despite all the discussion of risks.  Those are 9 mothers, sisters, daughters that can and should be saved!

I think that these new VBAC guidelines are certainly a step in the right direction, while the change may not take place overnight, we are seeing that it is something now being addressed on a large public forum as the backlash of high cesarean rates are starting to take their toll on our women and babies.