Sat 24 Jul 2010
Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women — including those who are carrying twins, according to guidelines released this week by The American College of Obstetricians and Gynecologists (ACOG). This is great news for women expecting twins. Previously, VBAC was not recommended for women carrying twins although there were no conclusive studies to suggest that twins posed a higher risk.
In fact, VBAC was often not recommended for many women, and the rate of C-sections in the United States had risen significantly over the past four decades. In the 1970′s, the C-section rate was about 5%, but by 2007, it was up at a whopping 31%. One reason for the increased rate of C-sections was due to insurers, doctors, and hospitals opting for a repeat C-section rather than attempting a trial of labor after cesarean (TOLAC).
TOLAC and VBAC do present some added risk. If uterine rupture occurs (between 0.5% and 0.9% of the time), it is an emergency situation that can cause serious harm to a mother and babies. For this reason, TOLAC and VBAC should only be undertaken in a hospital where an emergency C-section can be performed in the event of complications.
Patients and doctors will need to work together on a case by case basis to determine if TOLAC and VBAC are appropriate. New moms having twins should do their research and come prepared for a discussion with their OB/GYN about the possibility for VBAC with twins if that is their desire. Patients who encounter doctors that won’t even consider VBAC for a twin pregnancy should consider moving to another doctor. While there may be very valid reasons why a VBAC is not appropriate for your particular twin pregnancy, you should expect your doctor to cover those reasons with you in detail rather than rejecting the option out of hand.
These new guidelines will provide women expecting twins with more options than were readily available previously. And when you’re having twins — your options are often limited and out of your control. So bringing back options is always a good thing. And reducing the number of “automatic” C-sections is a good thing. Hopefully these guidelines will help to reduce the overall number of C-sections being performed in the United States.
Source: The American College of Obstetricians and Gynecologists, “Ob-Gyns Issue Less Restrictive VBAC Guidelines“, July 21, 2010.
Copyright 2010 Kathryn Whiteley — TwinParenthood.com