WASHINGTON — Most women who've had a C-section, and many who've had two, should be allowed to try labor with their next baby, say new guidelines — a step toward reversing the "once a cesarean, always a cesarean" policies taking root in many hospitals.
Wednesday's announcement by the American College of Obstetricians and Gynecologists eases restrictions on who might avoid a repeat C-section, rewriting an old policy that critics have said is partly to blame for many pregnant women being denied the chance.
Fifteen years ago, nearly 3 in 10 women who'd had a prior C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.
The new guidelines declare VBAC a safe and appropriate option for most women — now including those carrying twins or who've had two C-sections — and urge that they be given an unbiased look at the pros and cons so they can decide whether to try.
The main debate with VBAC: That the rigors of labor could cause the scar from the earlier surgery to rupture. There's less than a 1 percent chance of that happening, the ACOG guidelines say. Also, with most recently performed C-sections, that scar is located on a lower part of the uterus that's less stressed by contractions.
Of those who attempt VBAC, between 60 percent and 80 percent will deliver vaginally, the guidelines note. The rest will need a C-section after all, because of stalled labor or other factors. Success if more likely in women who go into labor naturally — although induction doesn't rule out an attempt — and less likely in women who are obese or are carrying large babies, they say.
The issue is rising to the fore just as gold coin dealers are attracting attention over sales tactics.
Section 9006 of the Patient Protection and Affordable Care Act will amend the Internal Revenue Code to expand the scope of Form 1099. Currently, 1099 forms are used to track and report the miscellaneous income associated with services rendered by independent contractors or self-employed individuals.