Toward an ethically responsible approach to vaginal birth after cesarean.

Abstract:

:Determining approach to delivery after a previous cesarean is among the most contentious areas of obstetrics. We present a framework for ethically responsible guidelines and practice regarding vaginal birth after cesarean. We describe ethical complexities of 3 key issues that mark the debate: the cesarean delivery rate, safety, and patient autonomy. We then describe a taxonomy of considerations that should inform a responsible framework for guideline development and highlight critical distinctions between types of guidelines that have been blurred in the past. We then forward 2 central claims. First, in otherwise uncomplicated birth after a single previous cesarean, both vaginal birth after cesarean and repeat cesarean should be regarded as reasonable options; women, rather than policymakers, providers, insurance carriers, or hospitals, should determine delivery approach. Second, in complicated cases, providers and policymakers should carefully calibrate the strength of evidence to ensure differential risk and cost are adequate to justify directive guidelines given important variations in values women bring to childbirth.

journal_name

Semin Perinatol

journal_title

Seminars in perinatology

authors

Lyerly AD,Little MO

doi

10.1053/j.semperi.2010.05.007

subject

Has Abstract

pub_date

2010-10-01 00:00:00

pages

337-44

issue

5

eissn

0146-0005

issn

1558-075X

pii

S0146-0005(10)00053-4

journal_volume

34

pub_type

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