WASHINGTON - Too many pregnant women who want to avoid a repeat Caesarean delivery are being denied the chance, concludes a government panel that urged doctors to rethink litigation-spurred policies that have swung the pendulum back toward the days of "once a C-section, always a C-section."
Fifteen years ago, nearly 3 in 10 women who had a first C-section were able to deliver their next baby vaginally, a trend called VBAC for "vaginal birth after Caesarean." Now that rate has dropped to 1 in 10, in part because a third of hospitals and half of physicians ban women from attempting VBAC, a panel of specialists convened by the National Institutes of Health said yesterday.
But VBAC remains a safe alternative for the right candidates, and when those women try labor, between 60 percent and 80 percent of the time they do give birth vaginally, the NIH panel concluded.
It urged that doctors offer mothers-to-be an unbiased look at the pros and cons, so they can decide for themselves.
"We believe that many women should have an opportunity to give it a try," said panelist and Delaware obstetrician Dr. Nancy Frances Petit of the U.S. Uniformed Health Services.
Overall, nearly a third of U.S. births are by Caesarean, an all-time high. Caesareans can be lifesaving but they come with certain risks - and the more C-sections a woman has, the greater the risk in a next pregnancy of problems like placenta abnormalities or hemorrhage.
Decades ago, doctors almost always recommended a repeat C-section, worried that the rigors of labor could cause a uterus scarred from the first surgery to rupture. But in 1980, government experts concluded that many mothers could safely deliver vaginally the next time, citing evidence that their risk of a uterine rupture was less than 1 percent.