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New guidelines for vaginal birth after C-section

An independent panel of medical experts explored the currently available information about the risks and benefits of both a vaginal delivery, and a repeat cesarean delivery.

The inherent fear over complications linked with attempting vaginal birth after a cesarean section (VBAC) has led to the practice of "once a C-section, always a C-section."

The accessibility and safety of VBAC has become a controversial issue, and experts are examining the reasons behind the constant decline in pregnant women who had caesarean section before trying for normal childbirth.

A conference by the National Institutes of Health (NIH) was convened in Bethesda, Md., U.S. because doctors, patients, and policy makers believe the existing VBAC policy is misguided and potentially hazardous.

An independent panel of medical experts explored the currently available information about the risks and benefits of both a vaginal delivery, and a repeat cesarean delivery.

Comparing the maternal deaths and infant deaths in VBACs and repeat C-sections, the panel found that four out of 100,000 women in vaginal delivery die as opposed to 13 in a repeat C-section, and that 130 of 100,000 infants in VBAC attempts die compared with 50 in repeat C-sections.

New guidelines recommended
After a thorough review of various studies the panel of experts concluded that VBAC was just as safe as normal births with just minor risks that can be handled with extra care.

“We found the use of VBAC is certainly a safe alternative for the majority of women who’ve had one prior Cesarean, provided that the incision was horizontal and low on the uterus”, said Dr. F. Gary Cunningham, the conference chairman and a professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center in Dallas.

He further said, “About 70 percent of women who have had Cesareans are good candidates for trying for a normal birth, and 60 percent to 80 percent of those who try succeed."

The medical experts reiterated that women be given the option to make a choice of the delivery method after being educated about the risks and benefits linked with the procedures.

"There's still a lot we don't know about which women will be successful in having a VBAC, but we believe it's essential that women's desires and preferences be respected throughout the decision-making process," Cunningham said.

They also advised the policy makers to re-evaluate the national guidelines that prompted many healthcare providers to ban VBAC.

Lastly, they suggested a need for more and better research on risks and benefits of both approaches.

The risks highlighted
The practice of repeat C-section continues primarily due to the risk of the uterus tearing along the scar during vaginal labor, which can be life threatening.

This was the reason why doctors did not allow VBAC to be available unless the delivery room was equipped with surgical and anesthesia services in case of an emergency.

Another potential risk highlighted during this three-day conference was that repeated C-sections can cause placenta-related complications which can lead to dangerous maternal bleeding and pre-term birth.

Fear of murky lawsuits is another reason why many gynecologists refuse vaginal deliveries after cesarean sections.