The American College of Obstetricians and Gynecologists has loosened up its recommendations regarding women who've previously given birth via ceserean section but want to deliver vaginally the next time around.

As the WSJ reports, now women who have already had two C-sections and those who are pregnant with twins following a C-section delivery are candidates for so-called VBACs, so long as their operations included a low-on-the-abdomen, horizontal incision.

While ACOG still recommends that women attempt vaginal delivery only if they're in a facility that has "staff immediately available to provide emergency care," the group says that if those resources aren't available the woman should "be allowed to accept increased levels of risk" if they are informed about the potential dangers and availability of facilities and staff. There are risks associated with all variations of childbirth, including vaginal birth and C-section.

Will the guidelines do anything to budge the C-section rate, which stood at more than 31% in 2007, according to ACOG? After the last set of guidelines were released, that same "immediately available" language led some hospitals to refuse to allow women with a history of C-section to make an attempt at delivering vaginally by allowing labor to progress.

William Grobman, a co-author of the guidelines and an associate professor of obstetrics and gynecology at Northwestern University's medical school, says that's the wrong question to ask. "We are culturally very focused on outcomes -- the C-section rate, the VBAC rate," he tells the Health Blog. "But we aren't trying to achieve arbitrary rates. There's as much focus on process as there is on outcomes," he says, which is why the guidelines emphasize "autonomy, shared decisionmaking and the provision of information."

If there were a metric to track, says Grobman, it would be the percentage of medical charts that show "there was a clear discussion about the risks and benefits" of an attempt at labor by women with a history of C-section.

He says it's not clear how many women have wanted a VBAC but have been unable to get it due to hospital or physician policy, but that there were enough people speaking out at a recent NIH consensus conference on the topic to suggest "it's a problem of some importance."

Grobman says the new clinical guidelines won't be "the start and finish" of a shift in physician behavior and hospital policies, since those things are also shaped by personal experience and professional liability concerns. "That being said, there's no doubt the guidelines are an important foundation," he says.

The Obama administration unveiled new rules, today, specifying which preventive health services will be free to consumers under the new health law after Sept. 23. Mandated preventive care seeks to correct the problem of under utilization of preventive care services because of out-of-pocket expenses for consumers. Americans use preventive services at about 50% the recommended rate, according to research cited by the White House. Chronic diseases, which are often preventable, are responsible for 7 of 10 deaths among Americans each year and account for 75 percent of the nation's health spending.

Free preventive services are among the health insurance benefits that the White House is touting as it tries to show consumers that the health care overhaul has tangible benefits. The list of services likely to spark intense debate within the health industry over what's included and what gets left out.

• Children will get more than two dozen services, including vaccinations for influenza, diphtheria and tetanus, and screenings for hearing and vision impairment and autism.
• Women over 40 will still be able to get a mammogram screening every year or two.
• Colorectal cancer screening for adults over 50.
• Hepatitis B screening
• HIV screening for adults at high risk
• Depression screening for adults and adolescents
• Prenatal services including screenings for iron deficiency.
• Blood pressure screenings.
• Obesity screening and counseling for adults and children.
• Tobacco counseling for pregnant women

New health plans offered after September 23, 2010 must include these preventive services without a copayment or other direct costs for consumers on new health plans. However, these new health insurance plans are expected to be price higher than comparable old plans to cover the mandated services. Consumers who stick with their existing insurance plans won't benefit from the change, but it will become an individual health insurance comparison decision to determine if the new preventive benefits are worth the new health plan rates.

To determine which services qualify as preventive, government officials relied largely on existing recommendations by three groups, including the U.S. Preventive Services Task Force. The preventive services task force drew criticism last year for recommending that women delay annual mammogram services until age 50, instead of age 40. The health care law effectively ignores that recommendation, making mammograms a covered preventive service at age 40 under the law.

Americans who have been denied coverage because of a preexisting medical condition may begin applying July 1, 2010

The federal government and some state governments will begin accepting applications Thursday, July 1, 2010, for new insurance programs designed to cover people who have been denied health insurance because they have preexisting medical conditions. These so-called high-risk pools were included in the health insurance reform law, the Affordable Care Act. to provide relief for some of the most desperate uninsured Americans until 2014, when insurance companies will be required to cover everyone regardless of medical history.

Who will be eligible for the insurance plan?

American citizens and legal residents who have been without insurance for at least six months and have been denied coverage because they have a preexisting medical condition. Applicants in most states will need a recent copy of a letter from a private insurance company denying coverage altogether or denying coverage of a specific condition.

Which states will have programs and when?

These 21 states have asked the federal government to run the high-risk pool rather than administer it themselves: Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia, Wyoming. Residents of these states can apply starting July 1. Administration officials said people who apply by July 15 will begin receiving coverage by Aug. 1.

The remaining 29 states and the District of Columbia will run their own programs and begin accepting applications over the next several months. Several of the largest states operating their own plans, including California, Illinois and New York, are not expected to begin enrollment until August. The administration expects that all states will begin enrolling people by the end of the summer.

How much will the insurance cost?

Premiums, as well as benefits, are expected to vary greatly from state to state, with some plans charging as little as $140 a month and some as much as $900 a month, according to administration officials. Premiums could vary by age. And some states may offer a variety of benefit packages.

How do I sign up?

The federal government's new healthcare Web portal at http://www.healthcare.gov, will offer instructions. Residents of states where the federal government will run the high-risk pool will be able to find applications there. The website also contains instructions for residents of states that are running their own pools.

What if my state already has a high-risk pool?

Many states have been operating such pools for years, but some are prohibitively expensive or have been closed to new enrollees. Because the rules for the new plans will be different, administration officials are encouraging people who have been without coverage to consider applying for the new pools.

Will there be enough money to cover to everyone?

Very likely not. The new healthcare law allocated $5 billion for the new high-risk pools, but several independent analyses, including one by the nonpartisan Congressional Budget Office, have estimated that more money would probably be needed because demand will be so high. The Department of Health and Human Services will be able to shift money from states that are not using all their allotted funds to those that need more, but so far administration officials have been reluctant to talk about seeking more funds.