October 25, 2011

Comparing ACOG VBAC Guidelines

Last year, the American College of Obstetricians and Gynecologists released new guidelines on vaginal birth after cesarean (VBAC). ACOG’s stance on VBAC is considered extremely important, because it can have a strong influence on whether hospitals and individual providers are willing or able to offer VBAC as an option. The organization’s 2004 statement is widely considered to have drastically reduced the availability of VBAC in the United States.

The 2010 guideline place a greater emphasis on women’s right to be part of the decision-making process and to refuse cesareans, and indicated that women with two previous low transverse incisions, carrying twins, or with single previous cesarean with an unknown type of incision may be candidates for a trial of labor.

One thing that has always bothered me about from a research perspective is how ACOG guidelines are treated once they are updated. Once a new version is out, the old guidelines are essentially disappeared from all the online sources. As I wrote after speaking to an ACOG rep about this issue, it makes it really difficult to compare the old and new version if one wants to see them side by side and compare documents/changes. Immediate removal is probably great for clinicians and liability reasons, but it’s not so great for historical research and understanding changing policies and influences on birth practices over time.

Childbirth Connection has released a document that gives a very basic overview of changes related to VBAC in the 2010 ACOG practice bulletin compared to the 2004 VBAC and 2006 induction of labor for VBAC documents. While this comparison doesn’t have the full details, caveats, and discussion of having the ACOG documents in hand side-by-side, it’s a good starting point for understanding what has changed.

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