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VAGINAL BIRTH AFTER PREVIOUS CESAREAN DELIVERY
The following material is reproduced, with permission, from the
American College of Obstetricians and Gynecologists.
Vaginal Birth After Previous Cesarean Delivery
(Practice Bulletin No. 5). Washington DC, © ACOG, July 1999
View article in Adobe's "PDF" format
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VAGINAL BIRTH AFTER PREVIOUS
CESAREAN DELIVERY
While vaginal birth after cesarean (VBAC) has become a popular
birth option, CAP claims analysis reveals that a successful
VBAC outcome depends on:
- (1) appropriate VBAC candidate selection, and,
- (2) obtaining full informed consent from that patient.
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RECOMMENDATIONS / SUMMARY
The following recommendations are based on good and consistent
scientific evidence (Level A):
- Most women with one previous cesarean delivery with a low-transverse
incision are candidates for VBAC and should be
counseled about VBAC and offered a trial of labor.
- Epidural anesthesia may be used for VBAC.
- A previous uterine incision extending into the fundus is a
contraindication for VBAC.
The following recommendations are based on limited or inconsistent
scientific evidence (Level B):
- Women with two previous low-transverse cesarean deliveries
and no contraindication who wish to attempt VBAC may be
allowed a trial of labor. They should be advised that the risk of
uterine rupture increases as the number of cesarean deliveries
increases.
- Use of oxytocin or prostaglandin gel for VBAC requires close
patient monitoring.
- Women with a vertical incision within the lower uterine
segment that does not extend into the fundus are candidates
for VBAC.
The following recommendations are based on consensus and expert
opinion (Level C):
- Because uterine rupture may be catastrophic, VBAC should be
attempted in institutions equipped to respond to emergencies with
physicians immediately available to provide emergency care
(Emphasis added). After thorough counseling that weighs the individual
benefits and risks of VBAC, the ultimate decision to attempt this
procedure or undergo a repeat cesarean delivery should be made by the
patient and her physician.
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