Updated VBAC Guidelines Released by ACOG
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.