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VBAC Cubby - vaginal birth after cesarean

VBAC Reasonably Safe, Should Be More Widely Available, NIH Panel Finds
National Partnership for Women & Families
March 12, 2010

Vaginal birth after caesarean section is reasonably safe and more women should have access to it, an NIH advisory panel announced on Wednesday, the Los Angeles Times reports (Roan, Los Angeles Times, 3/11/10). The VBAC rate has declined from a peak of 28.3% in 1996 to less than 10% currently.

The NIH panel found the risks related to both additional c-sections and VBAC to be small, with a vaginal birth being safer for the mother and a c-section slightly safer for the infant. Panel experts said the general quality of data available on such risk divisions is poor. The panel said that because the risks and benefits differ, "this poses a profound ethical dilemma for the woman, as well as her caregivers, because benefit for the woman may come at the price of increased risk for the fetus and vice versa" (Grady, New York Times, 3/11).

The panel called for more study to discern which women are the best candidates for VBAC. Gary Cunningham of the University of Texas Southwestern Medical Center said the procedure best suits women who have had one prior c-section that has a "transverse" scar, the most common method of the surgery today (AP/MSNBC, 3/10).

The panel recommended that both anesthesiologists and obstetricians "reassess" guidelines from their professional groups that could dissuade physicians and hospitals from allowing VBAC. The guidelines require that surgical and anesthesia teams are "immediately available" during labor if a woman has had a prior c-section.

Neither group has said whether it would change its guidelines. Jeffrey Ecker, an obstetrician at Massachusetts General Hospital and vice chair of the committee that issues practice guidelines for the American College of Obstetricians and Gynecologists, said his committee would consider the panel's recommendations at its next meeting (New York Times, 3/11).

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