When I found out that ACOG released their new guidelines yesterday, I couldn’t wait to devour them. This morning, I had an opportunity to cuddle up with the new recommendations and I’m quite pleased. As always, there are things to like and areas where I think ACOG missed the mark. But here are the eleven good things about ACOG’s 2017 VBAC guidelines.
Spontaneous labor is always preferable to induced or augmented labor but there are medical conditions that can necessitate the immediate birth of a baby. It’s nice for those women for whom vaginal birth is still an option to have a choice: gentle induction/ augmentation or repeat cesarean. Of course, informed consent reviewing the risks and benefits of their options is essential. Some women might be more comfortable scheduling a cesarean whereas others might want to give a gentle Pitocin and/or Foley catheter induction a go.
“It’s no wonder that the cesarean rate is going through the roof and women are seeking alternatives to hospital-based OB/GYN care in unprecedented numbers,” said Susan M. Jenkins, Legal Counsel of The Big Push for Midwives. “ACOG’s very own recommendations give its members permission to follow opinion-based practice guidelines that have far more to do with avoiding litigation than with adhering to scientific, evidence-based principles about what’s best for mothers and babies.”
March 2005, the American Academy of Family Physicians published an evidence based clinical practice guideline on TOLAC (Trial of Labor After Cesarean; formerly called Trial of Labor Versus Elective Repeat Cesarean Section for the Woman With a Previous Cesarean Section). The AAFP guideline recommends offering a trial of labor to women who have had one previous cesarean delivery with a low transverse incision.
This is a great birth story, published with permission, of a woman who had a cesarean for “small pelvis” and then VBACed a larger baby at home! Since she is a neonatal nurse, it’s interesting to read why she chose HBAC and how she thinks her birth would have gone differently had she labored in a hospital.