A Step In The Right Direction (Orig Post Date 7/30/10)

Last week KCCI reported on a new set of less restrictive guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) that now favor vaginal birth after Caesarean (VBAC) as a viable option for women, even after two previous Cesarean deliveries. You can read the article in Medscape Today here (free account set up required) and the ACOG’s press release, which has even more information, here.



These new guidelines are an important step in the right direction. I agree, however, with Lamaze International that there is some wording in the new guidelines that can still limit a woman’s access to VBAC. As my doula explained, that’s where women, as consumers and paying customers, need to stand up and challenge the care providers. We need to tell them that this is what we want, and as the paying customer, we have every right to have the option.


The section of the ACOG’s press release that really gives me hope is this:


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 trial of labor after Cesarean.


The part that does worry me a little is the next sentence:


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.


I’m worried that physicians will just start refusing to see patients who want a VBAC.


I know that Iowa City is very pro-VBAC, and I have heard that there are some physicians here in Des Moines who are willing to talk about it, but with limited access to a willing facility, the conversation soon transitions from “We’ll see how you progress” to “Let’s go ahead and get you scheduled.” I sincerely hope that these new guidelines and the patient’s desire for options will help expedite the process of change.


A C-section rate of 31% is too high (up from just 5% in 1970), and I hope that these new guidelines will help lower that rate. However, I think the ACOG needs to look at the reasons for first time C-sections and work on changing the policies that lead to unnecessary medical interventions and, ultimately, a surgical delivery. It stands to reason that, if the initial number of C-sections can be reduced, then the number of subsequent C-sections will drop as a result.


This is a step in the right direction for a woman’s choice in how to birth her baby, but it is just the first step of what is likely to be a marathon. Let’s keep this momentum going. Talk to your doctor, and demand the options that are rightfully yours.