Thirty two percent of all births in the U.S. in 2007 (the last year for which figures are available) were by Caesarian Section. That’s a statistic that doctors and woman’s health advocates find believe is too high. A big part of the reason for those climbing numbers is the long entrenched hospital policy of not allowing VBAC (Vaginal Birth After Caesarean). A new set of guidelines released today by the American College of Obstetricians and Gynecologists is designed to make it easier for women who have had a C-Section to find a doctor who will allow them to try a vaginal birth on their next pregnancy.
The reason that, until the 1970’s, and in many cases still today, the rule of the thumb has been “once a C-Section, always a C-Section” is always been fears of uterine rupture during what doctors refer to as “the trials of labor.” Previous ACOG guidelines have insisted that, should a woman attempt VBAC, an anesthesiologist and surgeon be “immediately available” to perform an emergency C-Section should a rupture occur. This has led to many, if not most, hospitals banning VBAC because they can’t afford to keep staff on hand just on the chance that they’d be needed.
The statistical likelihood of a rupture in VBAC is, however, quite small is the C-Section was performed with a low and horizontal cut. Under 1%. The same goes for the increased risk of stillbirth with VBAC. The new guidelines attempt to put the decision as to how much of a risk to take in the hands of the mother, stating that, while emergency surgery options should still be “immediately available” if they are not, the mother can be notified and allowed to take the risk of VBAC and rupture anyway if she so chooses.
While women’s health advocates applaud the attempt to cut down on C-Sections, many doubt that it will have much affect on the policies of hospitals who are afraid of being sued if something goes wrong.
