Vaginal birth after cesarean underused: panel

If you're pregnant and have had a cesarean section before, chances are you'll have one again. In at least one-third of US hospitals, a repeat cesarean is the only option, and nine in 10 women end up getting one - a fact that had experts worried at a national conference this week on vaginal birth after cesarean, or VBAC.

Because VBAC doesn't require surgery, mother and baby can spend more time together and leave the hospital sooner than after a cesarean.

There is no agreement about how often VBAC should be attempted, but experts agree that the current overall cesarean rate - one-third of US births - is too high.

"The pendulum has swung too far," said Debra Bingham, president-elect of Lamaze International, a non-profit advocacy group that promotes non-medical childbirth techniques.

According to Bingham, participants at the three-day meeting in Bethesda, Maryland, agreed.

After reviewing earlier studies, the expert panel found that VBAC was about as safe as first-time vaginal childbirth. The panel emphasized that women should have access to the delivery method they prefer, and recommended that health-care providers and policymakers collaborate to eliminate current barriers to VBAC, including guidelines that limit availability of the procedure.

"The data indicate that hospitals are not able or willing to provide" VBAC, said Dr. F. Gary Cunningham, of the University of Texas Southwestern Medical Center at Dallas, who chaired the panel.

"We are just hoping that putting these data out there after this exhaustive review will prompt some people to look at the problem," he told journalists after the conference.

Bingham said Lamaze was pleased with the result, which was also welcomed by others at the meeting.

"There is quite a presence of young women who are not willing to be told what to do," she told Reuters Health from the conference, which was organized by the National Institutes of Health. "They don't want their reproductive decisions made by others."

CHANGING RECOMMENDATIONS

VBAC has long been the subject of heated debate. For decades, the mantra was "once a cesarean, always a cesarean." Doctors were concerned that the scar left in the womb from a previous cesarean would tear during labor, leading to life-threatening bleeding.

But in 1980, an NIH conference panel suggested that the chance of uterine rupture was small in most women and that VBAC was as safe as other vaginal births. Maternity wards soon began embracing VBAC as a means to slash high cesarean rates.

As more and more women gave birth vaginally, however, reports of uterine ruptures increased, and VBAC rates began to slump in the mid-1990s.

By 2004, they had dropped to less than 10 percent, despite high overall success rates between 60 and 80 percent for the procedures.