ACOG Changes VBAC Statement

Following the recent NIH conference on VBAC (Vaginal Birth After Cesarean) this past March, The American College of Obstetrics and Gynecology (ACOG) recently altered their statement on the safety of VBACs to make them more accessible for the majority of women who have previously had a cesarean birth.

ACOG's previous statement, issued in 1999, stated that hospitals have an anesthesiologist who could be "immediately" available to perform a repeat cesarean section on women attempting VBACs if necessary--a situation which even the largest hospitals in the country could rarely accommodate. ACOG's previous statement, issued after an NIH conference in 1980, suggested only that the necessary staff for an emergency cesarean be made "readily" available, helping to keep the U.S. cesarean rate at a relatively low percentage.

The change in wording in the official statement was prompted by a handful of articles published in medical journals in the late '90s regarding the incidence of uterine rupture in attempted VBACs. Though these articles relied on limited data, ACOG soon shifted it's stance on VBACs, thus being a major contributing factor in the incredible increase in the national cesarean rate over the past decade. 

In recent years, several more studies have suggested that attempting vaginal birth after prior cesarean is most often the safest option for women, backing the original data that prompted the ACOG statement prior to the 1999 change. These studies show that the chances of uterine rupture in labor due to a cesarean scar are below 1%, only increasing above 1% in cases where labor was induced or augmented. It is safe to say that ACOG is finally coming around to meet the evidence-based standards proven not only in the past several years, but in what was originally found throughout the 1970's and 80's.

This change should offer women more options in care providers and place of birth when attempting VBACs, though it may take several years to see this becoming a national trend. It is still to be seen whether or not this changes any stances on VBAC attempts in home deliveries, or for women who would wish to deliver at a birthing center, but this may open those options to women, allowing these practices to come out from the underground networks they are currently forced to transverse due to limited access.

Allowing more women to have vaginal deliveries should also cause a shift in the amount spent on births in the U.S. each year, and hopefully will send the national cesarean rate on a downward slope, edging closer, at least, to the World Health Organization's (WHO) recommended 15% (the U.S. currently has a 32% cesarean rate).