Practice Guidelines: ACOG Releases Guidelines for VBAC (Vaginal Birth After Cesarean Delivery)

Summary of Recommendations

• Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should be counseled about VBAC and offered a trial of labor.
• Epidural anesthesia may be used for VBAC.
• Women with a vertical incision within the lower uterine segment that does not extend into the fundus are candidates for VBAC.
• The use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged.
• Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.
• After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician. This discussion should be documented in the medical record.
• Vaginal birth after a previous cesarean delivery is contraindicated in women with a previous classical uterine incision or extensive transfundal uterine surgery.

Practice Guidelines: ACOG Releases Guidelines for Vaginal Birth After Cesarean Delivery - October 1, 2004 - American Family Physician http://www.guideline.gov/algorithm/7362/NGC-7362_4.html