Guidelines relax stance on vaginal birth after cesarean

New guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) are less restrictive about attempting vaginal birth after cesarean delivery (VBAC), reflecting concern about the soaring rate of cesarean deliveries in the United States.

The revised guidelines, released on July 21, emphasize the need for thorough counseling, shared decision-making, and patient autonomy, according to ACOG President Richard N Waldman, MD.

Previous guidelines suggested that most women with 1 previous cesarean delivery with a low-transverse incision are candidates for, and should be counseled about, VBAC and be offered a trial of labor before converting to cesarean delivery. The recommendations now include women who have had 2 previous cesarean deliveries, who are carrying twins, and those with an unknown type of uterine scar.

The bulletin on the revised guidelines is available on the ACOG Web site ( http://www.acog.org).