New VBAC Guidelines: What Would You Sacrifice for That Vaginal Birth?

Cynthia Dermody
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pregnant woman in obgyn officeWhile proponents of natural childbirth are cheering new regulations released by an influential obstetricians group today loosening restrictions on vaginal births after cesarean sections, I'm here thinking, This isn't going to change a thing.

If you haven't heard yet, the American College of Obstetricians and Gynecologists (ACOG) is finally admitting -- on paper -- what most childbirth advocates and moms on this site have been hammering for years: That most women with previous cesarean surgeries can deliver a subsequent child vaginally (VBAC) with very little risk. In its effort to lower the high rate of cesareans and give women more access to doctors allowing VBACs, the group even goes further to say that doctors and hospitals should ease off the big push for surgery and allow qualifying women to deliver naturally if they want to.

Wow. Symbolically, this is a huge victory. But realistically? These are doctors we're talking about. These are hospitals, businesses that are always watching the bottom line, and that means avoiding lawsuits at all costs.

The statistics about VBAC and the reason doctors try to avoid them -- a rupture to the uterus -- are not new. For women with one previous c-section, the risk of rupture during a trial of labor is quite low -- from 0.7 percent to 0.9 percent, according to The New York Times. If the same woman has a repeat cesarean instead, before labor starts, the risk of rupture is even lower -- from 0.4 to 0.5 percent.

Not much of a difference, huh? Docs have known these statistics all along and that didn't change anything before. It probably won't now, largely because of two words that the ACOG has chosen to leave in the guidelines: "immediately available." This refers to a team of surgeons who should be standing by at all hours ready to perform emergency surgery if something goes wrong. So, hospitals can either pay gads of money to have surgical teams waiting in the wings 24/7, or they can save money, lower their liability risk, and just ban VBACs. Which one do you think most hospitals will choose?

In the end, it's going to come down to this: Hospitals will allow more VBACs if women agree to assume more of the risk and forfeit some of their rights to sue if something goes wrong.

Would you sign this legal document?


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