ACOG Issues New VBAC Guidelines

In June of this year, The American College of Obstetricians and Gynecologists issued new and "less restrictive" guidelines for vaginal birth after c-section (VBAC). In the words of the release: "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans..."¹

For many women, this statement alone is a huge victory. Women have been told for years that to attempt VBAC is dangerous. This "DANGER!!" attitude has filtered into society to the point that women face pressure from all sides-medical and familial-to just schedule a repeat cesarean section. One acquaintance of mine was told by a relative that to attempt vaginal birth after her first cesarean birth would result in her uterus exploding. Being a new mom and not knowing any better, she was naturally terrified. This is one story among many, and many women have tired of scare tactics and manipulation.² Some have gone as far as to move into the birth "underground", birthing at home unassisted rather than risking a surgical birth or undergoing a second or subsequent one.

Because of these tensions between women and the birthing status quo, it is encouraging to note that the ACOG's release includes this quote as well: "The College says that 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 TOLAC [Trial Of Labor After Cesarean]. 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."

Furthermore, in this release the ACOG expresses concern about America's high rates of c-section and acknowledges that is a problem. They also acknowledge that liability concerns (created in part by a lawsuit-happy culture) have caused some hospitals and physicians to refuse VBACs across the board, regardless of individual women's levels of risks.

Perhaps the main reason this document is so hopeful for a change in American birth culture is that while it lays out the risks of VBAC, it encourages doctors to counsel women rather than pressure them, engages in positive discussion about VBAC, and urges changes from the current anti-VBAC climate in medicine today.

¹ Ob-Gyns Issue Less Restrictive VBAC Guidelines, official release, ACOG.org
²"Having Another VBAC Would Be Very Dangerous", myobsaidwhat.com