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VBAC Cubby - vaginal birth after cesarean

Detroit Free Press Examines Increased Incidence of C-Sections, Decline in VBAC Procedures
August 11, 2004

The Detroit Free Press on Tuesday examined the "growing trend" of doctors refusing to allow patients who have previously undergone caesarean sections to undergo vaginal deliveries with subsequent pregnancies because of a fear of being sued if the infant is born with any problems. Currently, approximately 26% of infants are delivered by c-section in the United States, and the percentage is continuing to rise because of an increase in the incidence of multi-fetus pregnancies, higher average birthweights, legal concerns of hospitals and doctors about vaginal delivery, delivery complications associated with obesity, "convenience" for doctors and families and more "conservative" guidelines from the American College of Obstetricians and Gynecologists, according to the Free Press. However, the percentage of women opting for vaginal birth after c-section has declined, according to the Free Press. In 1999, ACOG recommended that hospitals should not offer VBAC unless it could guarantee that "key staff," such as anesthesiologists, obstetricians and pediatricians, would be "quickly available" to perform emergency c-sections if necessary, the Free Press reports. This recommendation led many hospitals to stop offering VBAC procedures completely; 250 hospitals nationwide no longer offer the procedure, according to the Free Press. ACOG last month further advised that women who have had two or more prior c-sections should not be offered the option of VBAC because of the increased risk of uterine rupture, which can cause "disastrous" problems for both the woman and her fetus, according to Dr. Cosmas van de Ven, chief of maternal-fetal medicine at University of Michigan Medical School, the Free Press reports. However, between 70% and 80% of women who attempt VBAC have successful vaginal births, and most doctors agree that vaginal births, including VBAC, are safer for pregnant women than c-sections, the Free Press reports (Anstett, Detroit Free Press, 8/10).

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