Women underinformed about vaginal birth after cesarean, NIH panel concludes

By Aline McKenzie

May 2010

A National Institutes of Health panel, headed by Dr. F. Gary Cunningham, professor of obstetrics and gynecology, has found that women who have had cesarean-section deliveries in previous births are not receiving adequate access to or information about the possibility of having vaginal births in subsequent pregnancies.

Dr. F. Gary Cunningham

“You can’t make hospitals provide vaginal births after cesareans, but women should be aware that in many cases vaginal birth is an option to be considered,” said Dr. Cunningham. “We have women who tell us they’re not getting balanced counseling with the pros and cons of choosing a repeat cesarean delivery versus an attempt at a vaginal birth.”

The 15-member NIH Consensus Development Conference on Vaginal Birth After Cesarean panel stated that vaginal birth after cesarean (VBAC) delivery can be successful in women who meet certain criteria and who choose to try vaginal birth. The panel also said that overly strict professional guidelines and fear of lawsuits have led to a situation where at least a third of American hospitals and half of physicians will not even offer VBAC as an option.

The panel concluded that women at lowest risk for complications in labor, such as uterine rupture, should be counseled appropriately regarding risks versus benefits to them and their unborn babies. Each woman and her doctor should decide together whether to attempt a VBAC. Whenever possible, the woman’s decision should be honored, the panel concluded.

“Our intent is to put the evidence out there so women will be informed,” Dr. Cunningham said. “Regardless of which route of delivery is chosen, there are uncommon but catastrophic complications that cannot be predicted.”

The NIH Consensus Development Program was established in 1977 as a mechanism to judge controversial topics in medicine and public health in an unbiased, impartial manner. Recommendations of consensus panels are nonbinding. The VBAC panel comprised experts in various fields including obstetrics, anesthesiology, neonatology, nurse midwifery, epidemiology, law and ethics.

UT Southwestern’s obstetricians offer the option of VBAC to low-risk women, both at
UT Southwestern University Hospital - St. Paul and Parkland Memorial Hospital. Of women with at least one prior C-section who deliver at Parkland, about 15 percent will have a successful VBAC. In contrast, the national rate is 8 percent, a substantial drop from a peak rate of 28 percent in 1997. This drop was a major impetus for the NIH to convene a panel, Dr. Cunningham said.

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Dr. Cunningham holds the Beatrice and Miguel Elias Distinguished Chair in Obstetrics and Gynecology.