How’s this for a reversal?

The American College of Obstetricians and Gynecologists is set to issue a new set of guidelines intended to make it easier — easier! — for women who have already undergone a c-section to give birth vaginally.

ACOG’s new guidelines say that normal birth (meaning vaginal) is safe for most women who have had prior Cesarean sections, as long as the incision was low and horizontal — the typical cut for c-section births.

Women’s health advocates praise the new guidelines, especially in light of the evidence that VBACs are safe. Some 60 to 80 percent of women with a prior c-section who are allowed a trial of labor in subsequent pregnancies have successful VBACs.

Critics say the new guidelines don’t go far enough in requiring hospitals to offer a trial of labor. Women are still at the mercy of hospital protocols and doctor preferences. However, ACOG  says that even if a hospital doesn’t allow VBACs, they can’t use the policy to deny women care or to force them into surgery.

Another huge part of the new guidelines involve twin pregnancies. The college says that attempting a VBAC is reasonable even for women pregnant with twins and have had two prior c-sections.

But not all hospital officials are convinced. The new guidelines say the VBACs should be offered where an emergency c-section can be performed in necessary. But rather than requiring a surgical staff to be at the ready, ACOG agreed to soften its stance and say that if emergency requirements can’t be guaranteed, women should at least be informed of the increased risks for hemorrhaging and stillbirth.

Liability is still the big issue in all this. One ACOG member told the Times this about the new guidelines, which call for everyone to take responsibility for the outcome — patients, doctors and hospitals.

“What I’m hoping is that everybody will get together and do the right thing,” Dr. [Richard N.] Waldman, [president of the obstetricians’ group], said. “That includes patients. If they take the risk, they have a certain responsibility not to sue the physician if there’s a bad outcome, knowing that they took the risk.”

The new guidelines will be published Thursday in the August issue of Obstetrics & Gynecology.

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