Attempting a vaginal birth after a C-section is safe for most women, including women who have had two cesarean deliveries and women carrying twins, according to new guidelines issued Wednesday.
The guidelines, which update previous recommendations from the American College of Obstetricians and Gynecologists, widen the pool of women for whom natural delivery should be considered “safe and appropriate” after a Caesarean.
Ninety percent of pregnant women who have had a C-section opt for repeat surgery, while vaginal birth after C-section — known as VBAC — accounts for just 9 percent of deliveries.
“Moving forward, we need to work collaboratively with our patients, our colleagues, hospitals and insurers to swing the pendulum back to fewer Caesareans and a more reasonable VBAC rate,” said Dr. Richard N. Waldman, president of the gynecology group.
After peaking in the mid-1990s, vaginal birth after C-section has dropped off dramatically in the U.S., in large part because of restrictions imposed by hospitals concerned about malpractice lawsuits.
Successful vaginal birth has a shorter recovery time and carries a lower risk of complications for future pregnancies than C-section. But in less than 1 percent of cases, the uterus ruptures, requiring emergency surgery.
Dr. William A. Grobman of Northwestern University’s Feinberg School of Medicine, co-author of the guidelines, said they emphasize “shared decision-making” between women and their doctors.
“The best method is women getting information about the risks and benefits and working with providers to make sure they can have the approach to delivery that they want,” he said.
In separate guidelines released Wednesday, the gynecology group recommended that young women shouldn’t get routine Pap tests for cervical cancer before they’re 21 unless they have HIV or a weakened immune system.