In VBAC (Vaginal Birth after Cesarean)

The Royal College of Obstetricians & Gynaecologists has published updated VBAC guidelines based on studies published between 2003 and February 2015. The guidelines are more extensive and contain much more detailed information than the American version, but they are pretty much on the same wavelength, including the recommendation that VBACs be conducted in a hospital with “resources available for immediate caesarean delivery and advanced neonatal resuscitation” (p. 3). Disappointingly, the guidelines fail to dig below the surface of the data. For example, they note both that induction increases the risk of scar rupture and that post-dates pregnancy, high maternal BMI, and suspected big baby do so as well without making the connection that women with these factors are more likely to be induced. On the positive side, the guidelines also state that while the presence of risk factors should be considered during prenatal counseling, they do not contraindicate VBAC, but, then, U.K. obstetricians have long taken informed choice more seriously than most of their U.S. counterparts.

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