of Interest, since birth and breastfeeding are so intricately  related.
From Medscape  
_[log in to unmask]@.2a026287!comment=1_" target="_blank">http:[log in to unmask]@.2a026287!comment=1_ 
([log in to unmask]@.2a026287!comment=1" target="_blank">http:[log in to unmask]@.2a026287!comment=1) 
 
ACOG Issues New TOLAC Guidelines
 
 
Maria Rodriguez, MD, Ob/Gyn & Women's Health, 12:06PM Sep 1, 2010
 
The American  College of Obstetricians and Gynecologists  recently updated  
their practice bulletin with respect to women  who have had previous 
cesareans and wish to attempt a vaginal birth. The  College's previous 
recommendations had been criticized by many for being  too restrictive, lacking clarity 
and subsequently fueling decreased  availability of VBAC for women. 
Key changes in the updated practice bulletin include clarification of  the 
following: 
"Most" women with one previous low transverse scar are considered  
appropriate candidates for a trial of labor and should be counseled  accordingly 
(Level A evidence). 
Level B evidence now supports the recommendations that women with an  
unknown scar, two previous cesareans and a twin pregnancy can be offered a  trial 
of labor. 
Appropriate counseling for VBAC is critical to success, and should take  
place in the prenatal period. Multiple factors play into the  probability of 
successful VBAC, and several great tools exist to help  a woman consider her 
options. I particularly like the evidence based  calculator on 
perinatology.com that considers several individual factors  in weighing the probability 
of a successful VBAC for a woman. 
_http://www.bsc.gwu.edu/mfmu/vagbirth.html_ 
(http://www.bsc.gwu.edu/mfmu/vagbirth.html)  
What role does VBAC play in your practice? Do you think the updated  
guidelines will impact access on VBAC for women? While I would like to see  VBAC 
be an option for more women, and support the College's updated  guidelines, I 
am skeptical that they will have a large impact on  availability for women 
of a trial of labor following cesarean without a  drastic change in our 
medicolegal environment. What are your  thoughts?Poll: Will the new ACOG  
guidelines increase VBAC availability at your hospital? Yes|No|No impact|  





Peace,
Judy
 
 
Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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