ACOG: Classical incision a contraindication for VBAC
These are recommendations from the American College of Obstetricians and Gynecologists in Washington, DC, regarding cesarean sections and vaginal birth after cesarean (VBAC):1
• Until more studies become available, contraindications for a VBAC are a previous classical uterine incision, multiple gestation, and breech presentation.
• A woman who has had two or more previous cesarean deliveries with lower transverse uterine incisions, who has no contraindications and wishes to attempt vaginal birth, should not be discouraged from doing so.
• During the first stage of active labor, the fetal heart rate should be evaluated and recorded at least every 15 minutes when intermittent auscultation is used. If continuous electronic fetal heart rate monitoring is used, the tracing should be evaluated at least every 15 minutes. During the second stage of active labor, the fetal heart rate should be evaluated and recorded at least every five minutes when auscultation is used and evaluated at least every five minutes when electronic fetal heart rate monitoring is used.
• Epidural anesthesia should not be discouraged in VBAC. Because the availability and use of epidural analgesia may encourage a greater percentage of women to choose a trial of labor, patients should be advised of its availability in facilities that have the resources to administer it.
• Oxytocin use for induction or augmentation of labor is not contraindicated.
• Suspicion of macrosomia by itself in a nondiabetic patient should not disqualify a patient from a trial of labor.
• Available data are insufficient to determine the risks and benefits of using prostaglandin gel for VBAC.
• VBAC shouldn’t be limited to large subspecialty hospitals. Well-equipped basic and specialist hospitals with the capacity to respond to intrapartum emergencies are appropriate settings for VBAC.
Reference
1. American College of Obstetricians and Gynecologists. ACOG Practice Patterns August 1995; pp. 1-8.
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