the decision to VBAC

Heard of “VBAC,” but don’t really know what it is? Interested in having a VBAC, but need more information to make your decision? There’s too much fear around VBACs (vaginal birth after cesarean) circulating out there and slight risks (serious, but slight) are blown out of proportion. Want a repeat c-section? That’s okay, too, I just want to be sure women are making an informed decision, not one based on scare tactics.

1. About 75% of women that labor naturally for a VBAC are successful.

2. When discussing VBAC with a care provider, they’ll most likely bring up “uterine rupture” as a reason NOT to VBAC and to instead sign up for that repeat c-section. However, the risk of uterine rupture is around 0.2%. That means that 99.8% of the time, there is no rupture.

Where does the fear come from??? Back in the day, cesarean incisions were often made vertically (up and down) and higher up on the uterus–the most likely place for rupture to occur. Now, incisions (even in emergencies) are generally made low and transverse (from side to side), where rupture is very unlikely to occur. Check your hospital records and confirm the type of incision you had.

3. In a study of 36,000 women having VBACs, not even one died from uterine rupture, regardless of incision type. In a 10-year study (1988-1997) based on 114,933 deliveries, there were 39 ruptures (16 complete, 23 dehiscence). 37 of those 39 cases were women who had a previous c-section [10% of women in the study had a prior c/s, or 11,585 of the 114,993. That’s a uterine “rupture” rate of 0.32% for VBAC mamas]. There were NO maternal deaths, 33% of complete ruptures [=5-6 women of the 114,933] required a blood transfusion, and there was one neonatal death.

4. Rupture is a scary word and luckily it’s a misleading term. Even in that 0.2% of cases where it occurs, it’s not like the uterus explodes (as the term “rupture” might imply). What happens is the previous cesarean incision starts to pull apart and open. Most of the time, it’s gradual and is caught by a watchful eye (or fetal monitoring, if at the hospital).

5. CPD (cephalo-pelvic disproportion) does not mean you cannot have a VBAC. If you received this diagnosis as the reason for your first c-section, it means your pelvis was too small to fit the baby. This condition is very rare and even if you do truly have it, your next birth is likely to still be a successful VBAC. Your pelvis loosens with each birth and laboring/delivering in different positions can help open you up or allow the baby to find a way to fit through.

6. The more c-sections you have, the riskier birth becomes for both you and the baby because of all the scar tissue. Want more kids? Then you need to put a lot of thought into this decision for a repeat c-section.

7. Due dates can be off by up to two weeks, so if you schedule a c-section for 39 weeks, your baby could really be around 37 weeks. That leads to increased difficulties and NICU stays (~10% of cesarean babies end up in the NICU). Vaginal birth also helps to better prepare the baby for the outside world by effectively clearing their lungs and releasing needed hormones.

8. Have you had multiple c-sections and want a VBAC? New guidelines from ACOG state that risks for uterine “rupture” are the same (or only marginally increased) for a VBAC after two c-sections as they are for a VBAC after one c-section.

9. ICAN states (based on scientific research) that a VBAC is less risky for both moms and babies than a cesarean. RISKS of elective cesarean.

10. It’s your body, your baby, and your birth. It’s your decision. Whatever it is, be comfortable and happy with it–do not go into it with fear. Be ready to accept any outcomes from your decision (whether it’s a cesarean or a VBAC).

*I think I will do an upcoming post that’s more about VBACs vs. repeat c-sections… a more direct comparison of risks and benefits of each. Let me know if there’s anything else specific you’d like to see!

Sources:

http://www.askdrsears.com/topics/pregnancy-childbirth/pregnancy-concerns/vaginal-birth-after-cesarean/questions-you-may-have

http://ican-online.org/vbac/postion-statement-elective-cesareans-riskier-than-vaginal-birth

http://www.acog.org/

http://ican-online.org/vbac/uterine-rupture-a-10-year-population-based-study-uterine-rupture

http://www.ivillage.com/vbac-101-childbirth-choices-after-c-section/6-b-387701

 

8 comments to the decision to VBAC

  • I’m curious which link provides the information about CPD. I’ve had a few friends tell me this is why they had to have a c-section and I doubt they know they still have the option to try for a VBAC.

    [Reply]

    babydickey Reply:

    I doubt they know, too… there just isn’t enough education about it and there definitely isn’t proper informed consent. “Your baby is too big” is used WAY too often as an excuse for a c-section. CPD is very rare and is often misdiagnosed. It’s usually malposition of the baby (NOT a baby that’s too big) and having the mom try to labor in different positions may help the baby move or help the mom open up for that baby to find a way out. But most of the time, mom has an epidural and is on her back in a hospital bed and is unable (or not allowed) to move around.

    Here’s info on CPD: http://www.ican-online.org/vbac/cephalopelvic-disproportion-cpd
    and an awesome video about CPD and VBACs: http://www.youtube.com/watch?v=Dw5hYjxajN4

    [Reply]

  • It really bothers me that so many hospitals and physicians do not even consider VBACs. When I took a pregnancy class before my son was born, it was made VERY CLEAR to me that my hospital does NOT do VBAC…it’s ridiculous!! Women should be able to decide how they want to treat their bodies when it comes to such a special event as giving birth. If the hospitals are so worried, just create a waiver like everything else!!

    [Reply]

  • My external incision with my emergency c-section was the low transverse- but when I got my records when I was pregnant with the twins, we learned that once they got in there, they cut my uterus twice- once the low transverse, but then they had to cut vertically too so they could get her out safely. She was laying transverse herself- with her back up against my ribs.

    So basically my cut was like an upside down T.

    I was so bummed. If it had been all low transverse, I’d have been able to have the twins vaginally 🙁

    [Reply]

  • Thank you for this! I am 14 weeks pregnant with #2 and planning a vbac this time around.

    [Reply]

    babydickey Reply:

    Congrats!! 🙂

    [Reply]

  • Amanda Alvarado

    I am one of those rare 0.2% whose uterus ruptured (or started to). I was planning a VBAC with dd but when my Dr broke my water she was breach. My Dr. recommended a c-section because of her position and into the surgery room I went. As she opened me up, she discovered my uterus has started to tear/rupture and she could see my daughter! Of course it had been a little over 14 yrs since I had given birth so I’m sure that may have been part of it. She did recommend I NOT try another VBAC because I was now more likely than not to rupture again. Now that being said, we lost our next daughter at 30 wks and I was able to deliver VBAC. The Dr said that my uterus shouldn’t be stretched thin enough yet to rupture and it was less stress emotionally and physically to deliver her normally. I was given an epidural throughout my labor – when it started wearing off all I had to do was press the button for the nurse and they dripped(dropped?) in more meds through the spinal IV. We are starting Clomid tomorrow since for whatever reason I haven’t been able to get PG again in the past 2.5 yrs since loosing our dd. I’m not sure what I want to do this time around. Do I chance it and go for a VBAC or do I go the safe route and go for another c-section? Anything you can find on VBACs after rupture would be helpful! 🙂

    [Reply]

    babydickey Reply:

    So sorry, Amanda. I think the best thing you can do right now is go get copies of your medical records–the surgical report, mainly. There is a big difference between rupturing and “about to” rupture (or “starting to”).

    I don’t quite understand why the doc would let you vbac at 30 weeks, but say you’d be unable to vbac a full term baby. I understand the size, stretched uterus, etc. – but this is leading me to think you didn’t actually rupture, maybe the doc just saw a “window.” Anyway, the fact that you did successfully vbac that baby means something to me and you should be able to seriously consider a future vbac. Definitely check your medical records!!

    I’m here if you ever want to chat 🙂

    [Reply]

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