Bringing Back the VBAC
Vaginal births after Cesarean (VBACs) are an important part of the question surrounding the rising Cesarean rate in the US. While many organizations support access to VBACs, they are still elusive for many women. Transforming Maternity Care published an article by Amy Romano on Monday that begins:
If evidence supports VBAC as a “reasonable option” for most of this population and indeed the better option for many, it is time to be reasonable about how to make VBAC as safe, accessible, and satisfying as it can possibly be.
Unlike many recent articles about VBAC, this one doesn’t discuss whether VBACs are safe (although it does link to many resources regarding the safety of VBACs and various studies regarding them). Instead, this article deals with building a “quality framework” for increasing access and care.
Romano lays out three basic steps in building such a framework:
- Help more women make and implement choices that are informed by the best quality evidence and aligned with their own values and preferences.
- Maximize the proportion of women planning VBAC who experience uncomplicated vaginal births.
- Provide the best possible response to obstetric emergencies including uterine rupture.
Each of the steps are supported by information about the rationale for the step, a description of the current approach, why the current approach is not sufficient, and another approach that might be better suited to achieving the goal of more access to and more successful VBACs.
Romano’s article is unique in that it lays out clear steps, supported by links to evidence, for “bringing back VBAC.” While she acknowledges that VBACs may not be available - or even appropriate - for all women, the focus is in increasing access, giving informed consent, and allowing women and their providers to participate in a discussion to provide best care.
After you have read the article, what do you think about the steps Romano lays out? What about the other approaches she suggests would increase access and provide better care for women? Have you seen any of these approaches in action?