ACOG + VBAC: a tale of two acronyms

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Know what I just read over at The Feminist Breeder?

ACOG has changed its collective mind... Again!

So, now, ACOG (American College of Obstetricians and Gynecologists) is telling us what research has been telling us for a while. That for most women and babies, vaginal birth after cesarean (VBAC) is safe.

If I recall the on-again-off-again relationship between ACOG and VBAC, it goes something like this:

After several years of their friends saying they should get together, in 1994, ACOG said, "I love you VBAC! You and I, we will always be together!" And the VBAC rate went up.

Then, after a 4 year relationship, ACOG spurned VBAC, claiming she had been unhealthy, even deadly, though ACOG didn't really have anything to back up his claims. Not any texts, nothing on facebook, just what some of his friends (who never liked VBAC to start with) kept whispering. The VBAC rate dropped, as insurance companies, hospitals and doctors said they wouldn't do VBAC. They said she had cooties. Or something.

For more than 10 long years, VBAC has been fighting the misinformation, the tarnish on her reputation. Some people slammed the door in her face when she came knocking. Others knew the truth. ACOG had been misled. Some quietly looked away and let her go about her business. Her friends welcomed her with open arms, ignoring the threats and lies.

Finally, VBAC and her friends rallied together in March, 2010, to bring all the documentation of the truth to the light. ACOG digested this. ACOG thought some more, talked to his friends, and finally, issues a press release. ACOG said, "VBAC, we're not as tight as we once were, but we can be friends. Hugs?"

So the tale goes.

As I post in one of the forums I frequent:

Ultimately the message I take away from the press release is that now, ACOG says that it's generally safe (and maybe even a Good Idea) to encourage women to attempt a VBAC/TOLAC (trial of labor after cesarean). And, VBAC is even something to consider for women who have had 2 sections, who are pregnant with twins after a section, and even those who have an unknown uterine scar.

I thought it was especially interesting that they said this (emphasis mine):

The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.

So, considering this - if you are hoping for a VBAC, and your doctor says "no" because of policy, you can show them the ACOG press release, or refer them to the practice bulletin indicated at the bottom of the press release.

If you've had a previous cesarean (even two!) you have just a little bit more room to stand if you tell your doctor you want a VBAC. The road won't necessarily be easy. ACOG conveniently left a lot of space in their words to give hospitals, and doctors an out if they should want to deny a woman a VBAC. But still. A step in the right direction.