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-   -   ACOG revises VBAC guidelines! (http://www.diaperswappers.com/forum/showthread.php?t=1034149)

musicalisa 07-21-2010 04:31 PM

ACOG revises VBAC guidelines!
 
Great news for many of us out there:

http://www.acog.org/from_home/public...07-21-10-1.cfm

Quote:

For Release: July 21, 2010
Ob-Gyns Issue Less Restrictive VBAC Guidelines

Washington, DC -- Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists.

The cesarean delivery rate in the US increased dramatically over the past four decades, from 5% in 1970 to over 31% in 2007. Before 1970, the standard practice was to perform a repeat cesarean after a prior cesarean birth. During the 1970s, as women achieved successful VBACs, it became viewed as a reasonable option for some women. Over time, the VBAC rate increased from just over 5% in 1985 to 28% by 1996, but then began a steady decline. By 2006, the VBAC rate fell to 8.5%, a decrease that reflects the restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC) as well as decisions by patients when presented with the risks and benefits.

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

VBAC Counseling on Benefits and Risks

"In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor, all viewed in the context of her future reproductive plans," said Dr. Ecker. Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).

Both repeat cesarean and a TOLAC carry risks including maternal hemorrhage, infection, operative injury, blood clots, hysterectomy, and death. Most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has fewer complications than an elective repeat cesarean while a failed TOLAC has more complications than an elective repeat cesarean.

Uterine Rupture

The risk of uterine rupture during a TOLAC is lowóbetween 0.5% and 0.9%óbut if it occurs, it is an emergency situation. A uterine rupture can cause serious injury to a mother and her baby. The College maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency cesarean, but recognizes that such resources may not be universally available.

"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."

Women and their physicians may still make a plan for a TOLAC in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. "It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack "immediately available" staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added.

The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.

Practice Bulletin #115, "Vaginal Birth after Previous Cesarean Delivery," is published in the August 2010 issue of Obstetrics & Gynecology.

# # #

The American College of Obstetricians and Gynecologists is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 53,000 members, The American College of Obstetricians and Gynecologists strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care.


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Copyright © 2010 American Congress of Obstetricians and Gynecologists. All rights reserved.
:yay: :bliss:

supergirljennie 07-21-2010 04:36 PM

Re: ACOG revises VBAC guidelines!
 
Awesomeness! My local hospital just made a no-VBACs rule as the decided it was too risky. My DH works at the hospital with these people, and when he told me I became pretty upset about it even though it doesn't affect me - I just hate that they are taking choices away from women.

I will be sending DH to work with this, just to make sure the OBs in the practice are aware of the ACOG's recommendations :)

sjebillings 07-21-2010 04:53 PM

Re: ACOG revises VBAC guidelines!
 
Thank you for sharing! I would love a VBA2C but being high risk, not sure it is possible.

myall4him2 07-21-2010 05:10 PM

Re: ACOG revises VBAC guidelines!
 
unfortunately for some doctors, it's their medical insurance that won't cover it! There's an awesome OB here in town that wishes he could do VBAC's but his medical insurance simply won't cover it!

RochelleS 07-21-2010 05:31 PM

Re: ACOG revises VBAC guidelines!
 
That's a step in the right direction! Yay!

Also, read the ICAN response: http://www.ican-online.org/news/vagi...ion-most-women

CountryChicMama 07-21-2010 05:54 PM

Re: ACOG revises VBAC guidelines!
 
That is awesome!!

My Sweet Blessings 07-21-2010 06:17 PM

Re: ACOG revises VBAC guidelines!
 
wish I could have a VBA2C, but it's not likely to happen. I wanted to do a VBAC with my second child, but ended up agreeing to a c-section.

girlymama0104 07-21-2010 06:21 PM

Re: ACOG revises VBAC guidelines!
 
I am SO SO happy to read this!! Finally! 5 months too late for me, though :( I was denied a VBA2C last year by multiple providers, including an all midwife group :( I was not high risk.

My 3rd c/s went fine, but I am still sad I had to do it for no reason other than "you have no other options".

Whimsy Twist 07-21-2010 06:32 PM

Re: ACOG revises VBAC guidelines!
 
This is fantastic to read! I'm due to VBA2C any day now- and we were lucky to have found BOTH a hospital OB and a HB Midwife to agree to VBA2C me!!! We chose the HB- but it's good to know that there are some practices that are 'ahead of the times' in VBAC. (We also ran into MANY practices that wouldn't even consider it unless you have had at least 1 vaginal birth before a VBA2C, and many that wouldn't even consider a VBA2C regardless of the circumstances).

Thanks for posting!

norrahsmommy 07-21-2010 06:40 PM

Re: ACOG revises VBAC guidelines!
 
:woot: :lostit: :yay: :bliss:

There is hope for me! Thanks for sharing

girlymama0104 07-21-2010 06:53 PM

Re: ACOG revises VBAC guidelines!
 
Quote:

Originally Posted by Lilymomma (Post 10786227)
This is fantastic to read! I'm due to VBA2C any day now- and we were lucky to have found BOTH a hospital OB and a HB Midwife to agree to VBA2C me!!! We chose the HB- but it's good to know that there are some practices that are 'ahead of the times' in VBAC. (We also ran into MANY practices that wouldn't even consider it unless you have had at least 1 vaginal birth before a VBA2C, and many that wouldn't even consider a VBA2C regardless of the circumstances).

Thanks for posting!

This is what I encountered, too. If I had had one vaginal, I would have been able to attempt VBA2C with the midwife group. Our state also allows homebirth midwifes to (legally) provide only with one prior vaginal if you had more than one c/s. I am sure there are midwives out there that would do it anyway, but I wasn't comfortable with it.

Good luck to you! I hope you have an amazing VBA2C!

holly6737 07-21-2010 06:54 PM

Re: ACOG revises VBAC guidelines!
 
I heard Dr. Waldman speak like a month ago at the annual ACNM meeting. I think he's married to a Nurse Midwife. The relationship between ACOG and ACNM is headed in a warm direction. This makes me happy, especially as a VBACer myself.

Mom2frick&frack 07-21-2010 07:08 PM

Re: ACOG revises VBAC guidelines!
 
Such great news! And long overdue. Now we just have to get insurance carriers that insure the doctors to allow them to perform VBACs. Most of them will not allow a Dr to perform one.

BootyGold 07-21-2010 08:00 PM

Re: ACOG revises VBAC guidelines!
 
:touched:

Great news, thanks for sharing!

jaelynsmommy61607 07-21-2010 08:08 PM

Re: ACOG revises VBAC guidelines!
 
Another reason to TTC!!! I am so glad to hear drs supporting vbacs!

Mamatoabunch 07-22-2010 12:19 PM

Re: ACOG revises VBAC guidelines!
 
Honestly I am not jumping for joy. I have been in the pregnancy scene for 16 years now. My twins were delivered by c/s. W/ my second pregnancy I planned a VBAC, which was a HBAC. Women were completely encouraged to VBAC. Then it all changed b/c there were ruptures in VBAC moms, most often related to induction, specifically by cytotec. Instead of not inducing VBAC moms they said all VBACs were unsafe and stated they no longer supported VBAC b/c it was unsafe. Now they change their stance *again*. But what is millions of uneccessary surgeries on women? Honestly, how can women trust the ACOG? How can we put our bodies into their hands? It isn't their stance on VBAC that needs to change, but the whole system, until they view birth as a normal event women will continue to get cut uneccessarily.

musicalisa 07-23-2010 05:13 PM

Re: ACOG revises VBAC guidelines!
 
Quote:

Originally Posted by Mamatoabunch (Post 10792151)
Honestly, how can women trust the ACOG? How can we put our bodies into their hands? It isn't their stance on VBAC that needs to change, but the whole system, until they view birth as a normal event women will continue to get cut uneccessarily.

I hear you, mama. It's my hope that their recommendation will change the way that OBs (and even midwives who are dependent on OBs for backup care) view VBAC. I agree with you that the root of the problem is that the birth establishment views the birthing woman as a ticking time bomb, but perhaps these guidelines will relax the absurd shackles that have been put on so many women unnecessarily. The stories of women coerced into cesareans really haunt me. Here's hoping for less of that!

Mamatoabunch 07-23-2010 06:54 PM

Re: ACOG revises VBAC guidelines!
 
Quote:

Originally Posted by musicalisa (Post 10802938)
I hear you, mama. It's my hope that their recommendation will change the way that OBs (and even midwives who are dependent on OBs for backup care) view VBAC. I agree with you that the root of the problem is that the birth establishment views the birthing woman as a ticking time bomb, but perhaps these guidelines will relax the absurd shackles that have been put on so many women unnecessarily. The stories of women coerced into cesareans really haunt me. Here's hoping for less of that!

I hope so too. I think women need to stop putting their pregnancies and births in the hands of surgeons, women are the voice of change ultimately, it is in our hands. It is the reason I never went back to a surgeon to do such a simple job of birthing a baby, I stayed home.


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