Grassroots Network Message 508022
Family Physicians VBAC recommendations
Dear Friends,
Thank you Missy Thomas for preparing the following post:
The American Academy of Family Physicians (AAFP) recently published new recommendations regarding vaginal birth after cesarean (VBAC), which differ significantly from the current recommendations of the American College of Obstetricians and Gynecologists (ACOG).
The full text of the AAFP policy document can be found at:
http://www.annfammed.org/cgi/data/3/4/378/DC1/1
Some of the most notable highlights are:
~ “TOLAC [Trial of Labor After Caesarian] should not be restricted only to facilities with available surgical
teams present throughout labor since there is no evidence that these additional resources result in improved outcomes.”
~ “Our recommendation significantly differs from current ACOG policy because we could find no evidence to
support a different level of care for TOLAC patients. Without good-quality evidence, we believe that different levels of resources cannot be advocated because their potential for unintended harms cannot be evaluated against their purported benefits.”
~ “… the ACOG policy suggests that one rare obstetrical catastrophe (e.g., uterine rupture) merits a level of resource that has not been recommended for other rare obstetrical catastrophes (e.g., shoulder dystocia, abruptio placenta, cord prolapse) that may actually be more common.”
~ “… current risk management policies across the United States restricting a TOL after previous cesarean section appear to be based on malpractice concerns rather than on available statistical and scientific evidence."
ACOG currently recommends that an OB and an anesthesiologist should be “immediately available,” widely interpreted as being on the premises throughout the trial of labor. ACOG recommendations were based on “expert opinion.” In contrast, the AAFP recommendations are based on a comprehensive review of published medical studies, a much higher level of evidence for such recommendations. The ACOG recommendation of having a surgical team immediately available has possibly been one of the biggest limiting factors for hospitals allowing a VBAC, leaving women with limited or no options for avoiding a repeat cesarean section.
The AAFP guidelines certainly give family practice physicians more incentive to allow their patients to have a VBAC than the ACOG policy currently gives an Ob/Gyn. It will be interesting to see how the AAFP recommendations will factor into the current climate, and how useful they may be for women and birth advocates working to change hospital policies.
Sincerely,
Susan Hodges, “gatekeeper”
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