Lamaze’s Statement on ACOG’s New Clinical Management Guidelines on Vaginal Birth After Cesarean

July 21, 2010 - PRLog -- The American College of Obstetricians and Gynecologists (ACOG) has issued updated practice guidelines for planned vaginal birth after cesarean (VBAC) sometimes referred to as trial of labor after previous cesarean delivery (TOLAC).  These new guidelines are a step in the right direction, clearly stating that women with one previous cesarean should be offered VBAC.  Lamaze International is pleased to see several key components within the guidelines, including the acknowledgment that a woman’s choice for a planned VBAC should be honored; recognition of associated decrease in maternal morbidity and risk of complications in future pregnancies; and, affirmation that planned VBAC could decrease the overall cesarean rate.  However, Lamaze is troubled by elements of the guidelines which continue to support practices that may increase risks and cause undue harm to mother and baby.  

The revised guidelines acknowledge that requiring “immediately available” resources for an emergency cesarean have resulted in hospitals, insurers and the obstetric community issuing formal or informal bans of VBAC, effectively denying women access to care and choice in birth.  While this was not the intention, the “immediately available” language remains in the new guidelines, which may continue to unfairly limit women’s access to VBAC.

Additionally, the guidelines continue to emphasize risks of uterine rupture, a rare, but potentially dangerous complication, for women who choose a VBAC.  Unfortunately, this does not help women contextualize the benefits and risks of VBAC versus elective repeat cesarean delivery (ERCD).  

The medical evidence shows that most mothers with a previous cesarean section should be offered the opportunity to have a VBAC.  In fact, the guidelines state that women with two previous cesarean deliveries may be considered for VBAC.  While there are risks with a VBAC, ACOG’s guidelines recognize there are also dangers to both mothers and infants associated with a repeat cesarean, and particularly multiple repeat cesareans.  Therefore, it is critical for every woman to have the information and tools she needs to lower her risks for that first cesarean.  

To lower this risk, the guidelines provide additional direction around cervical ripening and labor induction.  

Lamaze strongly advocates for women to seek balanced and accurate information along with the care they receive in their physician’s office, like Lamaze childbirth education classes.  As independent experts, Lamaze Certified Childbirth Educators provide evidence-based information in an easy-to-understand format to support women to make informed decisions about planned VBAC and other childbirth questions.

The Six Lamaze Healthy Birth Practices could play a significant role in supporting VBAC candidates.  Additional research will lead to new insights on existing studies that suggest women, including VBAC candidates, can have their outcomes positively influenced by choosing healthcare providers who routinely use Healthy Birth Practices, like midwives or physicians who avoid interventions that are not medically necessary.

To learn more about the Six Lamaze Healthy Birth Practices visit www.lamaze.org/healthybirthpractices and enroll in a Lamaze childbirth education class.

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Lamaze International promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting practices. Knowing that pregnancy and childbirth can be demanding on a woman’s body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years. Lamaze education and practices are based on the best and most current medical evidence available. Working closely with their families, health care providers and Lamaze educators, millions of pregnant women have achieved their desired childbirth outcomes using Lamaze practices. The best way to learn about Lamaze’s steps to a safe and healthy birth is to take a class with a Lamaze certified instructor. To find classes in your area, or for more information visit www.lamaze.org.