Despite the negative effects of the ACOG practice bulletin on vaginal birth after cesarean, the document does contain many positive points that are often ignored by obstetric care providers. I encourage you to read the document if you are pursuing or deciding if you want to pursue a VBAC.
Here are a few highlights:
1. It is reasonable to attempt a trial of labor after cesarean if you have had two low transverse cesarean sections. This is also true if the woman does not know what type of scar she has.
2. While macrosomia may increase the risk of uterine rupture, this alone should not solely make the decision of repeat cesarean.
3. Going past her due date may decrease the likelihood of successful vaginal delivery, but this does not mean she should not attempt a TOLAC.
4. Twins have similar success rate of VBAC as singletons.
5. It is reasonable to induce or augment a TOLACs labor, but care should be taken in doing so.
6. External cephalic version (attempt to turn a breech baby vertex) can be considered to avoid repeat cesarean.
7. Women can chose epidural analgesia as in any labor.
If you are finding your provider is putting multiple stipulations of on your pursuit of a VBAC (delivery by due date, only if baby isn’t thought to be too large, etc) you may want to compare their care to this practice bulletin. In the end, you want a provider who believes VBAC is a good thing, rather than someone who will just “allow” it to happen under their strict criteria.