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Date: | Tue, 7 Sep 2010 21:00:17 EDT |
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of Interest, since birth and breastfeeding are so intricately related.
From Medscape
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([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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