VBACs in the National News
The cover story of our March issue was about VBACs, or Vaginal Birth After Caesarean. I think I had a small brain meltdown and wrote Vaginal Birth After Delivery in my Editor’s Note. I will take this time to apologize for the many typos I miss and my lack of a copy editor.
Moving forward, that article received a lot of response. I encourage everyone to respond to the VBAC article, and to any others, on our website. There is a place to respond at the end of each article, and I would love to see an ongoing conversation there. Look for some letters and more information on VBACs in the April issue of TulsaKids and on www.tulsakids.com.
Coincidentally, I just read a New York Times (March 11, 2010) article, “Panel Urges New Look at Caesarean Guideline” by Denise Grady. For those who are interested in the topic, it might be worth a read. It covers similar issues to our VBAC article and discusses recent recommendations from the National Institutes of Health after a conference this week in Bethesda, Md. As we pointed out in our article, the U.S. Caesarean rate has been rising over the past 10 years or so, and one of the reasons is that fewer and fewer VBACs are performed. The NIH panel wanted to find out why VBAC rates are so low even though medical professionals say that a VBAC can be a viable option for many women. The New York Times article quotes Dr. F. Gary Cunningham, a professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center in Dallas, as saying that a VBAC can be “a safe alternative for the majority of women who’ve had one prior” Caesarean, depending on the placement of their incision.
According to the NYT article, a panel of medical experts at the conference made the recommendation that the guidelines of professional groups for obstetricians and anesthesiologists be “reassessed.”
The experts quoted in that article express the same concerns about the safety of VBACs for the mother and fetus that were raised in our March article but, even with the risks, the NIH still recommends changing the guidelines to make VBACs more accessible to more women.
The guidelines state that a team of surgeons and anesthesiologists must be available during a VBAC in case of emergency. Many hospitals are unable to comply with this guideline.
Also, doctors and hospitals may be reluctant to perform VBACs because of the potential for lawsuits, and many insurers charge higher premiums to doctors who perform VBACs.
Whether or not the anesthesiologist and obstetric groups will change their guidelines for VBACs based on the NIH recommendations remains to be seen.
Women who are in the middle of this will have to sort through and find the best information they can as they work with their doctors to achieve the healthiest outcomes for themselves and their babies.