WASHINGTON – Too many pregnant women who want to avoid a repeat cesarean delivery are being denied the chance, concludes a government panel that urged doctors to rethink litigation-spurred policies that have swung the pendulum back toward the days of "once a C-section, always a C-section."
Fifteen years ago, nearly 3 in 10 women who had a first C-section were able to deliver their next baby vaginally, a trend called VBAC for "vaginal birth after cesarean."
Now that rate has dropped to 1 in 10, in part because a third of hospitals and half of physicians ban women from attempting VBAC, a panel of specialists convened by the National Institutes of Health said Wednesday.
But VBAC remains a safe alternative for the right candidates, and when those women try labor, between 60 percent and 80 percent of the time they do give birth vaginally, the NIH panel concluded. It urged that doctors offer mothers-to-be an unbiased look at the pros and cons, so they can decide for themselves.
"We believe that many women should have an opportunity to give it a try," said panelist and Delaware obstetrician Dr. Nancy Frances Petit of the U.S. Uniformed Health Services.
What sparked the latest shift? It's partly concern over litigation, the NIH panel said, because while a uterine rupture remains very rare, it can be devastating to the family and end in a high-dollar lawsuit.
Case-by-case decisions are crucial, the panel said, because there may be instances where another C-section is better for the baby but not for mom or vice versa.
Who's a good candidate? The panel said that needs further study. But in general, VBAC is for women who've had one prior C-section done with a "transverse" scar, the most common kind today, said panel chairman Dr. F. Gary Cunningham of the University of Texas Southwestern Medical Center at Dallas. Women should be otherwise low-risk, he said: Not carrying multiples or a large baby, being obese or having high blood pressure or diabetes.