ACOG Practice Bulletin Discusses How to Determine Candidacy for VBAC
November 8, 2017 | Strategic Insights for Health System
When vaginal birth after cesarean delivery (VBAC) is achieved, it is linked to lower maternal morbidity and lower risk for complications in later pregnancies than is elective repeat cesarean delivery, according to practice bulletin No. 184 from the American College of Obstetricians and Gynecologists (ACOG) published in the November 2017 issue of Obstetrics & Gynecology. Generally, "most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about and offered" a trial of labor, state the recommendations in the practice bulletin. However, a failed trial of labor after cesarean delivery is linked to higher maternal and perinatal morbidity than either repeat cesarean delivery or VBAC. Therefore, when determining whether a patient is a candidate for trial of labor after cesarean delivery, it is important to assess the patient's individual risks and evaluate the probability of VBAC, according to the practice bulletin. The recommendations state that maternal patients who are at high risk for uterine rupture (e.g., patients with a T incision, history of uterine rupture, or history of "extensive" transfundal uterine surgery) or have other contraindications to vaginal delivery (e.g., placenta previa) are not candidates for trial of labor. Other factors may increase risk without necessarily being an absolute contraindication.