Vaginal Births After C-Sections? New Guidelines Say OK

(July 22) -- A vaginal birth is often a safe option for women who've previously given birth, even twice, by cesarean section.

That's the conclusion of a new set of guidelines issued by the American College of Obstetricians and Gynecologists. The advice runs counter to what many obstetricians once recommended: that women who've given birth by C-section avoid vaginal births.

C-sections account for about one-third of all births in the United States, which most experts say is simply too high. And 90 percent of women who've had one opt to go the same route for subsequent deliveries.

"Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals and insurers to swing the pendulum back to fewer cesareans and a more reasonable [vaginal birth] rate," Dr. Richard N. Waldman, president of the American College of Obstetricians and Gynecologists, said in a statement.

Uterine rupture is the biggest risk associated with vaginal births after cesarean (also known as VBAC), and occurs in 0.5 to 0.9 percent of patients. Overall, however, vaginal births are safer, are less invasive and require less recovery time after delivery.

Hospitals have also been less inclined to offer vaginal births in recent years, after a spate of malpractice lawsuits from women who suffered complications. A 2009 survey by the International Cesarean Awareness Network found that 30 percent of hospitals enforced a non-VBAC policy.

But new research, technology and medical training mean VBAC is safer than ever, and the new guidelines are emphatic that women should discuss options with their doctors.

"Respect for patient autonomy supports that patients should be allowed to accept increased levels of risk; however, patients should be clearly informed of such potential increase in risk and management alternatives," the guidelines read.