There is a petition going around to address the barriers to VBAC caused by the American Congress of Obstetrics and Gynecology’s “immediately” available guideline for practitioners. You can read the text here:
The purpose of this petition is to let ACOG know that women desire greater access to VBAC, or vaginal birth after Cesarean. The recent NIH VBAC consensus conference has stated “Given the available evidence, TOL is a reasonable option for many pregnant women with a prior low transverse uterine incision….When both TOL and ERCD are medically equivalent options, a shared decision making process should be adopted and, whenever possible, the woman’s preference should be honored…..We are concerned about the barriers that women face in accessing clinicians and facilities that are able and willing to offer TOL. Given the level of evidence for the requirement for “immediately available” surgical and anesthesia personnel in current guidelines, we recommend that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess this requirement relative to other obstetrical complications of comparable risk, risk stratification, and in light of limited physician and nursing resources.” We, the undersigned feel that VBAC is unreasonably and unfairly restricted because of the current ACOG recommendation that a surgeon and anesthesiologist be ‘immediately available’ during a TOLAC (trail of labor after Cesarean). Far too many women are undergoing unwanted and probably unnecessary Cesarean surgery because of this. We would like to note that the likelihood of the baby dieing during a TOLAC is the same as the likelihood of the baby dieing during a nulliparous (first time moms) labor, however ACOG doesn’t recommend a surgeon and anesthesiologist be ‘immediately available’ for first time moms going through labor. We find this discriminatory, inconsistent and unfair. We plead for ACOG to change the recommendations so that ALL low risk VBAC mothers across America can have the chance to give birth to their babies in a normal, safe, healthy way (VBAC).
You can find the petition and sign it here: http://www.PetitionOnline.com/VBAC2010/