The pendulum is swinging back yet again and the American College of Obstetricians and Gynecologists has recommended that most women who have had C-sections, and even those who have two, should be allowed to try labor with their next baby!
We discussed in March on this blog the possibility of this guideline reversal and you guys felt very strongly about it. We had more than 240 comments on the story.
“Fifteen years ago, nearly 3 in 10 women who’d 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 if 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.”
I like the doctor’s point that the new guidelines are all about giving women the choice! If you aren’t comfortable trying to push and are worried about popping your incision then have another C-section. But if you want to try labor and pushing, then go for it.
So what do you think: Would you want to try to have a VBAC? Are you glad to have the option? Do you think it’s a worthwhile goal to give more women the chance to give birth vaginally? Does it really matter how the baby comes out? (I do believe recovery time and sometimes safety it does.) Do you wish you have been given a choice — which would you have chosen?
(Check back at 2 p.m. for a second topic.)