The American College of Obstetricians and Gynecologists (ACOG) recently released an updated Practice Bulletin on vaginal birth after cesarean section (VBAC). It continues to recommend that a trial of labor after a c-section (TOLAC) be offered only at facilities that have immediately available resources for emergency cesarean deliveries. ACOG based the following recommendations on good and consistent scientific evidence:
- Most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about and offered TOLAC.
- Misoprostol should not be used for cervical ripening or labor induction in patients at term who have had a cesarean delivery of major uterine surgery.
- Epidural analgesia for labor may be used as part of TOLAC.
Other recommendations and a review of maternal risk factors are elaborated on in the Practice Bulletin. ACOG’s Committee on Practice Bulletins-Obstetrics, in collaboration with William Grobman, MD, published the new recommendations in the November issue of Obstetrics & Gynecology.