Most women who have had a previous cesarean delivery are good candidates for a trial of vaginal birth after cesarean (VBAC) delivery, including women carrying twins and those with 2 previous surgical deliveries, according to a new guideline from the American College of Obstetricians and Gynecologists.
The new guideline softens some of the college's previous recommendations, which had led some physicians and hospitals to enact very restrictive policies on VBACs or to ban them altogether. Such restrictions, as well as concerns by patients and clinicians about the risk of a trial of labor after a previous cesarean, contributed to a declining rate of VBACs, which peaked around 28% in 1996 and decreased to 8.5% in 2006, according to the college. Lower rates of VBACs are also believed to be contributing to overall high rates of cesarean deliveries, which made up nearly a third of all deliveries in 2007.
Kuehn BM. Obstetrics Group Relaxes Guideline for Trial of Labor After Cesarean Delivery. JAMA. 2010;304(9):951-952. doi:10.1001/jama.2010.1216