NEW BIRTHING GUIDELINES
Group: Women should be allowed to make decision based on pros, cons
Women should be allowed to try labor with next child, even after having a caesarean
WASHINGTON — Most women who have had a Csection, and many who have had two, should be allowed to try labor with their next baby, say new guidelines — a step toward reversing the “once a caesarean, always a caesarean” policies taking root in many hospitals.
Wednesday’s announcement by the American College of Obstetricians and Gynecologists eases restrictions on who might avoid a repeat C-section, rewriting an old policy that critics have said is partly to blame for many pregnant women being denied the chance.
Fifteen years ago, nearly 3 in 10 women who had had a previous C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.
Last spring, a National Institutes of Health panel strongly urged steps to reverse that trend, saying a third of hospitals and half of doctors ban women from attempting vaginal birth after a caesarean.
The new guidelines declare the option safe and appropriate for most women — now including those carrying twins or who have had two C-sections — and urge that they be given an unbiased look at the pros and cons so they can decide whether to try.
Women’s choice is “what we want to come through loud and clear,” said Dr. William Grobman of Northwestern University, co-author of the guidelines. “There are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making.”
Overall, nearly a third of U.S. births are by caesarean, an all-time high. Caesareans can be lifesaving, but they come with certain risks — and the more C-sections a woman has, the greater the risk in a next pregnancy of problems, some of them life-threatening, such as placenta abnormalities or hemorrhage.
The main debate with vaginal birth after caesarean: that the rigors of labor could cause the scar from the earlier surgery to rupture. There’s less than a 1 percent chance of that happening, the guidelines say. Also, with most recently performed C-sections, that scar is on a lower part of the uterus that’s less stressed by contractions.
Of those who attempt vaginal birth after caesarean, 60 to 80 percent will deliver vaginally, the guidelines note. The rest will need a C-section because of stalled labor or other factors. Success is more likely in women who go into labor naturally — though induction doesn’t rule out an attempt — and less likely in women who are obese or are carrying large babies, they say.
Thus the balancing act that women and their doctors weigh: A successful vaginal birth after caesarean is safer than a planned repeat C-section, especially for women who want more children — but an emergency C-section can be riskier than a planned one.