Your Family

Aug 2, 2010 3:08 PM by Carina Corral

One guideline, two policies: Local hospitals differ on labor after C-section

New guidelines for pregnant women is putting two local hospitals at odds.

The American College of Obstetricians and Gynecologists, or ACOG, now encourages women, who have had a prior Cesarean section, to try natural childbirth.

It is an effort to reduce C-sections, which are at an all time high with a third of U.S. births by Cesarean.

Nipomo mother of two, Holly Todd gave birth to her first child by Cesarean and her second by "vaginal birth after C-section," or VBAC.

Holly said after her C-section she was in bed recovering for nearly two weeks, but after natural childbirth she was at the grocery store the next day.

If given the option again: " I would chose a VBAC.

It's just better recovery and you're able to get up and going again. It's important with two kids," said Holly.

ACOG could not agree more and wants more moms to make that choice.

It has revised its guidelines to say women, even those carrying twins or who have had two prior C-sections, should give natural childbirth a try.

Holly was given the option at Sierra Vista Regional Medical Center in San Luis Obispo, which has offered the service for five years.

" Most C-sections done today are performed by doing a low transverse incision on the uterus, this has shown to be a very strong and durable uterine incision," said Ob-Gyn Dr. Lickness, who performs VBAC at the hospital.

However, Marian Medical Center in Santa Maria is sticking to its policy, 'once a cesarean, always a cesarean.'

" There's a one percent risk to mom's that they could have a ruptured uterus and that puts the baby at very high risk for a poor outcome. We just aren't willing to take that risk right now," said Marilyn Propst, R.N., Marian's Director of Perinatal Services.

The new guidelines still recommend VBAC only be performed at hospital's equipped for emergency C-sections with an obstetrician and ananaesthesiologist immediately available.

" Until we can guarantee that we could have an anaesthesiologist and an obstetrician at mom's bed during labor after she's had a C-section we will continue to do Cesarean deliveries after they've had a C-section," said Propst.

Dr. Lickness argues that wording should be taken out of the guidelines. "They're encouraging people to look at the safety factor but they haven't changed their word, their wording still says immediate availability and that is going to be a problem."

A recent study finds a third of hospitals and half of doctors ban women from attempting VBAC.

While new guidelines say it's now safer, they also say the decision should be made by a woman and her doctor, not by hospitals.


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