|December 2004 · Vol. 16, No. 12
VBAC: When is it safe?
When do risks outweigh benefits, in light of ACOG’s newly cautious advisory? What conditions call for extra concern?
Women who at first appear eligible may harbor conditions that call for special vigilance.
Personally review the prior operative note before attempting a trial of labor.
The less time between deliveries, the more likely is uterine rupture.
Associate Professor, Department of Obstetrics and Gynecology,
Columbia University Medical Center,
Selection criteria useful for identifying candidates for VBAC include: a limit of 1 prior low-transverse cesarean, clinically adequate pelvis, no other uterine scars or previous rupture, and no contraindications.
Offer VBAC only if obstetric care and anesthesiology are available throughout active labor, in case emergency cesarean is necessary.
Single-layer uterine closure may increase the risk of rupture during subsequent labors.
Epidural anesthesia is safe for women undergoing a trial of labor.
A woman’s first cesarean may be more fateful than ever, because 1 low-transverse cesarean delivery is the new limit for a trial of labor in subsequent pregnancies, advises a 2004 practice bulletin from the American College of Obstetricians and Gynecologists (ACOG).1 The previous bulletin on vaginal birth after cesarean (VBAC) recommended a limit of 2.
The new bulletin reaffirms the previous recommendation that obstetric and anesthesia personnel be immediately available throughout active labor, in case emergency cesarean is necessary.