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Clinical Practice Guideline Executive Summary: Labor After Cesarean/Planned Vaginal Birth After Cesarean
Bellinda K. Schoof , and colleagues
Background A clinical practice guideline summary from the American Academy of Family Physicians offers evidence-based recommendations to help guide clinicians in planning for labor and planned vaginal birth after a prior Cesarean delivery.
What This Study Found The multidisciplinary panel recommends that clinicians counsel, encourage and facilitate planned vaginal birth after cesarean (PVBAC), and offer pregnant women referrals to facilities or clinicians who can offer the service if PVBAC is not locally available. Additionally, the panel strongly recommends that clinicians inform women who have had a prior vaginal birth that they have a high likelihood of vaginal birth after cesarean (VBAC). Absent specific contraindications to a vaginal birth, they assert these women should be encouraged to plan labor and vaginal birth after cesarean. Lastly, the panel recommends that induction of labor after cesarean (LAC) is appropriate for women who have a medical indication for induction of labor and who are planning an LAC/VBAC.
Implications
- The panel calls for increased access to clinicians and facilities capable of managing LAC/VBAC in order to reduce the US cesarean rate and associated maternal morbidity while increasing choice for childbearing women and their families.