There are several major reasons why this choice has been precluded in most hospitals, Cunningham said. "The number of hospitals offering 'trial of labor' is diminished because of the perceived good and bad outcomes that accrue to either the mother or the fetus," he noted.
Although these outcomes are relatively rare, they include a ruptured uterus, and they can be devastating to the mother, Cunningham noted.
In many cases, access to vaginal delivery is not available to these women because of lack of money, as well as doctors' and hospitals' fear of being sued should a complication occur, he added.
In addition, some professional societies, such as the American College of Obstetricians and Gynecologists (ACOG) have guidelines that in some cases are impossible to follow, which have caused many hospitals to shy away from offering vaginal delivery to women who have had a Cesarean delivery, Cunningham said.
For example, the ACOG guidelines require that a surgeon and an anesthesiologist be immediately available when a woman who has had a previous C-section gives birth vaginally.
However, there's no evidence that this type of oversight is necessary or changes outcomes, Cunningham said. In any case, bad outcomes remain rare -- Cunningham estimated that there are about 10 deleterious outcomes for every 100,000 births, vaginal or otherwise.
"That doesn't mean it doesn't apply, just that there is no evidence to support that," he said. "It is a crippling rule for many hospitals and physicians, and is therefore a big driver of the problem. We hope that some of the recommendations cause some of these barriers to be removed."
Yet, there are no reliable means to spot which women are at risk for complications if they opt for vaginal delivery, the panel members noted.
"Pregnancy is something of a risky endeavor," panel member Ca
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