The New York Times has recently reported that the American College of Obstetricians and Gynecologists has begun to loosen the guidelines permitting Vaginal-Birth After Caesarian (VBAC). The New Yorks Times seems to see this as a step in the right direction, although VBAC is a potentially dangerous situation which any patient considering the procedure needs to be aware of.
First, VBAC may be contraindicated based upon the type of incision used in any prior C-section. Be sure that only a "low transverse" incision was used.
Second, the American College of Obstetricians and Gynecologists have used the term "immediately available" to near to a VBAC an OB doctor should be when a patient is undergoing a VBAC. This amorphous terms should mean that an OB is in the hospital ready to actually perform a C-section in less than fifteen minutes. This is because soon after fifteen minutes have passed following a uterine rupture, it is believed that irreversible brain damage begins to set in.
Third and finally, be wary of any induction during a trial of labor, especially the use of off-label medications such as Cytotec a/k/a misoprostol. Induction agents may further increase the risk of uterine rupture in any VBAC, and these risks are often not explained adequately to the patient.
Whether a mother should elect VBAC or not is based on several factors, but if you are considering either VBAC or a trial of labor, be sure to press your doctor or midwife excessively about the risks involved, the medications that will be used, and how soon a medical doctor can be called to perform an emergent C-section if signs of uterine rupture beging to show.
