Reactions to the New ACOG Statement on VBAC

By Rachel Walden |

Following up on last week’s ACOG release of an updated VBAC practice bulletin – this one with an increased emphasis on maternal autonomy – we thought we’d take a look around the web for what others are saying about the new statement.

From organizations:

Lamaze International calls the new guideline “a step in the right direction, clearly stating that women with one previous cesarean should be offered VBAC,” but wonders if there is too much of the “immediately available” language still in the current version.

Choices in Childbirth applauds the new version for “encourag[ing] autonomy for women in their maternity care decisions.”

The International Cesarean Awareness Network expresses that ACOG is going to need to take “an active role in educating both women and practitioners about healthy childbirth practices; practices that not only encourage VBAC but discourage the overuse of primary cesareans” in order to “reverse the over a decade long trend of increasing cesarean rates and decreasing VBAC rates.”

From the blogs:

Birthing Beautiful Ideas expresses that the importance of the new guideline is “not because it will effect any immediate policy changes but because it gives women a tool to help them facilitate discussions with their care providers and/or their local hospitals so that they can advocate for their birthing options.”

Jill at The Unnecesarean asks How will ACOG handle the PR challenge of promoting VBAC as a safe option? and wonders how the organization and individual physicians will approach the shift in attitudes toward VBAC that the new bulletin represents. She also has links to coverage at several other blogs.

The Well-Rounded Mama is lighting virtual fireworks over the bulletin’s Good News for Vaginal Birth After Multiple Cesarean! (The new guideline says that women with two previous low transverse incisions can be considered candidates for a trial of labor)

Amie Newman at RHRC, Babble, and Broadsheet also discuss the new guideline.

Seen other online commentaries or responses worth a look? Please share them in the comments!

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8 Comments

  1. I’m curious as to why you limited your summary of reactions to blogs run by laypeople with an ideological agenda. How about exploring what doctors, policymakers and average women think about the new guidelines?

  2. Rachel says:

    Hey, Amy, those were the ones I found when I did some initial blog/web searching for responses that included any commentary (rather than just a link to the ACOG press release or news coverage). I’m sure it’s not comprehensive – I don’t think it comes as a surprise that people and organizations who are particularly interested in/active about these topics were among the first to respond, but other responses of interest may exist or be written in the near future (I didn’t see one from you, by the way). As invited in the post, everyone is welcome to share links to additional commentaries – from doctors, policymakers, other organizations or individuals, their own responses, etc. – in the comments here.

    Everybody – be aware that multiple links may get you stuck in the spam filter until we get a chance to release them.

  3. Thanks for the explanation, Rachel. I realize that a lot of the commentary is coming from pro-VBAC activists, but they have very little power to influence anything.

    In contrast, I’ve seen several pieces on med-mal blogs instructing lawyers and those considering lawsuits that nothing has really changed. Indeed, ACOG still recommends “immediate” availability of a surgical team, the very wording that led to the restriction on VBACs in the first place.

  4. David says:

    I am an obstetrician at a small community hospital with over 30 years practice experience. I attended hundreds of VBACS during the 80’s and 90’s but have not been able to offer them for the past 10 years because of the lack of “immediate availability of emergency personnel” recommended by ACOG. Unfortunately, this most recent opinion on the part of ACOG leaves small town obstetricians and small hospitals in an impossible position. We must either provide emergency surgical capability ( which most small hospitals cannot afford to do ) or accept the potential liability associated with VBAC’s in the absence of such capability or be chastised by all of the lay groups advocating VBAC for not doing so. I’m thinking it’s about time for me to retire!

    By the way, I have seen two cases of uterine rupture during trial of labor following cesarean section in my career. I managed both at the tertiary care hospital where I once practiced and in both cases started surgery within 10 minutes of making the diagnosis. Of the four patients involved ( two moms, two babies ) only one mom survived and she needed to have a hysterectomy, many units of transfused blood and was hospitalized in serious condition for several weeks. Uterine rupture is rare but it is a very serious complication and I hope never to see another one, especially in a small hospital where it can take 30 minutes or more to get a patient to surgery. How does one truly communicate that to a woman considering VBAC?

  5. John says:

    I liked David’s comment of 7-29-10. I have done OB for 26 years. I have seen the pendulum swing back and forth over that time. First, VBACS are safe and some states MADE you VBAC. Then they weren’t so safe, and you had to have an OR crew on standby. Once they encouraged a single layer closure of the uterus, then we were to go back to a 2 layer closure. It seems we are at the mercy of the whims of the specialists at times. What’s next? Maybe only specialists can do VBACS?