March 10, 2010 - Hospitals and professional societies should end bans that that keep many women who've had a C-section from opting for a natural birth in later pregnancies, an NIH advisory panel today urged.
About 75% of women succeed in having a vaginal delivery after previous cesarean delivery, assuming that it's not a multiple birth, that the baby is in the normal position, and that their previous C-section required only a single incision.
But women who might want to give labor a try very often don't get a chance. That's because of so-called "VBAC bans" -- hospital policies that forbid a vaginal birth after a cesarean (VBAC) unless fully equipped and staffed surgical and anesthesia services are readily available. These policies align with current guidelines set by gynecology and anesthesia professional societies.
Not all hospitals are able to comply with this standard, so many women who have had a C-section have no choice in the matter. In fact, 30% of hospitals stopped offering women this choice after the professional-society guidelines went into effect.
The panel of experts heard three days of testimony and scientific presentations on questions surrounding VBAC. In the end, they urged the professional societies to reconsider their guidelines and urged hospitals to reconsider their policies. However, the panel has no power to force a change in policy.
Panel chairman F. Gary Cunningham, chair of obstetrics and gynecology at the University of Texas Southwestern Medical Center, noted that much more research is needed before doctors can identify the rare women who suffer VBAC complications.
While rare, the complications can be severe and even fatal. However, panel member Carol J. Rowland Hogue, PhD, MPH, director of the women's and children's center at Emory University, noted that VBAC isn't the only risk for a pregnant woman.
"Pregnancy is something of a risky endeavor," Hogue said at a news conference. "Women do suffer complications and their babies do have problems. Fortunately these are rare -- but they occur irrespective of mode of delivery. The very rare experience of maternal death is higher for C-section regardless of whether it is primary or repeat. This is very important for providers to weigh."
Hogue, Cunningham, and other panel members pointed to a research agenda set out in the panel report. They strongly suggested that professional societies and hospitals would offer women more choices if they had a better understanding of the consequences of offering -- and not offering -- VBAC.