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NIH to Recommend VBACs: Vaginal Birth After Cesarean

Posted Mar 10 2010 12:00am

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I have many friends and family members that have delivered their first babies via Cesarean surgery.  Subsequent births were scheduled c-sections; the mothers were given no choice in the matter. Only one of these women actually experienced a vaginal birth after Cesarean ( VBAC ) delivery, and that was because she went into labor before her scheduled surgery.  The idea that once a Cesarean always a Cesarean is changing, as international experts agree labor should be attempted by all women.  The question is…will US insurance companies allow women to try?

According to Reuters India , experts told the National Institute of Health (NIH) :

The experts cited “rigorous research” showing that at least trying natural labour is successful in nearly 75 percent of cases, and women are less likely to die if they are allowed to labour naturally for a while, even if they end up delivering surgically.

“Declining vaginal birth after Caesarean rates and increasing Caesarean delivery rates over the last 15 years would seem to indicate that planned repeat Caesarean delivery is preferable to a trial of labour,” Dr. F. Gary Cunningham, chairman of the NIH expert panel, said in a statement.

“But the currently available evidence suggests a very different picture: a trial of labour is worth considering and may be preferable for many women,” added Cunningham, the chairman of obstetrics and gynaecology at the University of Texas Southwestern Medical Centre at Dallas.

Statistically, 40 percent of C-sections in the US occur in women with previous surgical births.  Many doctors and insurance companies fear previous incisions will burst during labor; however, this occurs in only one percent of VBACs.

A draft statement on VBACs by the NIH is suppose to be released tonight.  It is expected they will recommend all women be given a chance at vaginal birth no matter past labor experiences.  In the structured abstract for Vaginal Birth After Cesarean: New Insights, Agency for Healthcare Research and Quality , part of the US Department of Health 7 Human Services, concludes:

Each year 1.5 million childbearing women have cesarean deliveries, and this population continues to increase. This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans. Relatively unexamined contextual factors such as medical liability, economics, hospital structure, and staffing may need to be addressed to prioritize VBAC services.

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