Panel Advocates New VBAC Guidelines

An independent panel of health professionals convened by the National Institutes of Health (NIH) in Bethesda, Md. on March 10, voiced their concerns for the decline of vaginal birth after cesarean (VBAC) services and recommended current guidelines be revisited.

The current overall cesarean delivery rate is 31 percent and the VBAC rate is less than 10 percent compared to 28 percent in 1996.

“Declining VBAC rates and increasing cesarean delivery rates over the last 15 years would seem to indicate that planned repeat cesarean delivery is preferable to a trial of labor. But the currently available evidence suggests a very different picture: a trial of labor is worth considering and may be preferable for many women,” said Dr. F. Gary Cunningham, panel chair, and chair of obstetrics and gynecology at the University of Texas Southwestern Medical Center at Dallas.

Research shows that a trial of labor (TOL) is successful in nearly 75 percent of cases and yet pregnant women are generally advised against VBAC by their physicians, the panel said.

The panel urged professional societies to revisit existing VBAC guidelines; in particular, the recommendation for “immediate availability” of surgical and anesthesia personnel as prerequisites for offering TOL. The panel also advocated for additional research to develop clear, evidence-based risk assessment tools to assist mothers and providers in the decision-making process from early pregnancy through delivery. The panel also recommended that policymakers and providers collaborate in the development and implementation of appropriate strategies to address and mitigate malpractice concerns.

Meeting details and a complete listing of the panel members and their institutional affiliations is included in the panel statement.

Source: NIH News, March 10

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