ABNORMAL LABOUR - VBAC

The Recent History of VBACs

In its 1995 bulletin, the American Congress of Obstetricians and Gynecologists (ACOG) recommended that repeat cesareans be limited, and encouraged a trial of labor after cesarean (TOLAC) – even after two previous cesareans.

In 1999 they stated that a physician should be on call to perform an emergency cesarean “just in case.” This severely limited a woman’s right to try a VBAC birth in hospitals without 24-hour anesthesiology, forcing those women to either birth in an alternative hospital, or to schedule a repeat cesarean. This was the case, even though research did not indicate “any improvement in maternal or infant death rates related to the characteristics of hospitals or the availability of physicians.”

In their 2010 bulletin, ACOG maintained its previous recommendations, but they also declared a host of precautionary measures, many of which were founded upon inconclusive research. So what does the research indicate?

Risk of uterine rupture for VBAC mothers
Fewer than 1 in 100 women who’ve had a low transverse uterine incision experience a rupture while attempting VBAC. Importantly, the phrase “uterine rupture” encompasses a spectrum of ruptures, and only small percentage of these are true ruptures that include the entire uterine incision. This “is the same as the risk of death for any baby at the end of a first pregnancy