National panel addresses vaginal births after cesarean delivery

A panel organized by the National Institutes of Health is mulling changes to guidance on vaginal births among women who have previously undergone cesarean delivery.

The panel issued a statement on March 10 recommending that vaginal birth after cesarean (VBAC) be considered on a case-by-case basis in women who have discussed the issue with their physician and are aware of the benefits and risks associated with the 2 types of deliveries.

The rate of VBACs has declined to less than 10% from 28.3% in 1996, and the subsequent surgeries are boosting the country’s total cesarean delivery rate of 31.8%, a percentage that has climbed consistently since 1999.

Also put forth by the panel was a reconsideration of current national guidelines that led many hospitals to forbid vaginal delivery for women who had already undergone cesarean delivery. Obstacles to VBACs, such as lawsuits, should be made preventable as well, according to the panel.

For physicians who recommend not proceeding with vaginal delivery, the most common concern cited is the possibility of uterine rupture at the site of the scar from the prior cesarean delivery.

The panel’s recommendations can be viewed and downloaded at http://consensus.nih.gov/2010/vbac.htm.