VBAC's are safe: study

by Kristin Darguzas (Subscribe to Kristin Darguzas's posts) Jul 2nd 2006 7:00AM

Categories: Pregnancy & Birth, Health & Safety

I've written before that I have some regrets about having a cesarean. It was not what I wanted, or expected. I am extremely fortunate to have a happy, healthy baby boy and I know that in the grand scheme of things, that's all that matters.

But I had hoped for a natural birth and, until recently, believed that my chances of that ever happening with a second baby were nil. Most of the women I know who had cesareans for their first baby were automatically scheduled another one for their second.

But a new article gives me hope that perhaps vaginal births after c-section might be on the rise.

A new study in Obstetrics and Gynecology notes that even women who have had multiple c-sections can safely deliver a baby vaginally. The incidence of uterine ruptures from a vaginal birth were only marginally higher in women who'd had more than one cesarean.

A spokesman for the American College of Obstetricians and Gynecologists, Gary Hankins, told USA Today he expects his group will revise its advice for women who've had multiple C-sections. And that's excellent news for so many women who have delivered via c-section but yearn to one day deliver non-surgically.

Source

Comments (11)

Reader Comments (Page 1 of 1)

Noelle LoConte 7-02-2006 @ 8:33AM

This is great news. I too was disappointed in needing (Well, at least that's what the OB tells me) a c-section with baby #1. Now the key is finding an OB who believes this study and will allow me to VBAC, even if I need another c-section. I am willing to bet that because this is a such a paradigm shift among the obstetrical community that it will be slow to catch on.

suburban misfit 7-02-2006 @ 9:39AM

I had to have a c-section with my first (Pelvic Dysmorphic Disorder, meaning that his huge head was too big to go through my small pelvis; he was ten pounds at birth). When I got pregnant again, I was living in a different part of my city and wanted to find a new OB. The one I found let me know in no uncertain terms that we were definitely going to try a VBAC. I was scared because I didn't want the same outcome (26 hours of labor, three hours of pushing, and then a surgery that took me three months to recover from). I'm so glad she made me try. My daughter was born after nine hours of labor (mostly at home) and only about 15 minutes of pushing. It helped that she was only seven pounds, but without my OB's encouragement, I probably would have settled for a scheduled C-section.

I highly advocate VBACs but it seems like most women who had experiences similar to mine don't want to try. I know I didn't, but I'm so incredibly thankful that I had the VBAC. Open communication with your OB or midwife is crucial. Knowing that the person helping you isn't going to let you suffer is a big comfort.

Amy 7-02-2006 @ 10:01AM

That's great news. I tried unsuccessfully for a VBAC with my second, and I've given up hope of every having a third because I just can't afford to the cost of another c-section and my insurance has said HELL NO. My doctor goes by the book, so if the recommendations are revised, then I know she'll consider letting me try again.

ivy 7-02-2006 @ 12:49PM

Another great resource is the ICAN network: http://www.ican-online.org/ You can search for VBAC friendly midwives and physicians, learn stats, how to argue for a VBAC, etc.

Thank god there are c-sections for the women and babies that have them - i know no one who wants to banish them all together - but knowing that so many women come away from their birth unsatisfied for no good reason, is disapointing.

brandi 7-02-2006 @ 1:48PM

I am really glad that they are updating these standerds but it doesnt say in the article what type of C-section was originally given. As i understand if you have a horizontal cut on the uterus then the risk of uterine rupture is very low. However if you have had a vertical incicsion sometimes called a classical then it really does increase your risk for uterine rupture. I am all for women being able to choos as long as they are fully informed of the risk. I can't imagine a woman choosing a vbac if there are truly risk involoved when in the end the natural birth is only what we feel not the baby. I personally had to have am emergency c-section with my first due to extreme complications and while it wasn't what i had in mind at all things happen and now i am having a second and due to the way i was cut the first time i will be having another c-section. My doctor made sure i understood and took the time to explain why another c-section would be needed. I also did my own research and feel ok with having another c-section as long as it a healthy happy baby then i can sacrfice my own want for a natural birth. I just hope women are making fully informed decisions when deciding on vbacs.

L. 7-02-2006 @ 4:03PM

I scheduled a repeat c-section for my second birth -- against my doctor`s wishes. He wanted me to attempt a VBAC.
I feel fortunate that I had a doctor willing to allow me to decide. I hope all women, whether they want VBACs or surgical births, find doctors who respect their decisions.

Joey's Mom 7-02-2006 @ 8:03PM

I had a C-section with #1 after 23 hours of labor. His head was just to big. I'm now 31 weeks prego with #2. My OBs office is comprised of 4 OBS and 2 midwives. My OB (who I love) wants me to schedule a C-section and the midwife (who I also love) encourages to atleast try a VBAC. I am deadset against another C-section. If your office has both an OB and midwives, I suggest speaking with both to hear from both sides, before you make the ultimate decision.

emjaybee 7-02-2006 @ 10:34PM

This is great news, but that doesn't mean a woman wanting to VBAC won't have to fight.

Which brings me to the second point; your doctor doesn't "let you" try for VBAC. Nor can they, **by law,** force you to have one. EMTALA (google it) states clearly that laboring women have the right to determine what procedures can and can't be done to them--and furthermore, a doctor has no right to drop you without referring you to another doctor, and they have to give you 30 days notice. Signing the admittance forms at the hospital doesn't change this, either. Your body and your baby's birth belong to you. You cannot legally be forced to induce, use Pitocin, stay in bed, have an IV, or have any other intervention--and the hospital cannot just put you out on the curb if you refuse. I don't think enough women know that.

Finally, the "classic" vertical incision is hardly ever used nowadays, so that's a bit of a red herring. But back when it was used, there were women who VBAC'd with them.

Michelle 7-03-2006 @ 10:08AM

I had an emergency c/s with #1 after many hours of back labor and pushing, including a crowning head. (She was laying on her side and they couldn't get her to turn) When I got pregnant with #2, I wanted VBAC, mainly because the epidural did not work for me during either laboring or c/s and I felt everything they were doing to be, including the scalpel cut. When we discovered I still had some health issues left over from my first pregnancy (my first was only 15 mos) my OB HIGHLY recommended a repeat c/s. He said there was a high probability I would have to be on bedrest again and that they would want to have the option of induction, because it would not be healthy for the baby or me to remain pregnant past the 38-40 week term. An induction apparently increases the chances of uterine rupture. We discussed it thoroughly with the OB, each other and my Mom,who is a NICU RN and decided the best course of action was one that would give us a healthy baby and mom.

Unfortunately, the decision was taken out of our hands, because I entered the hospital at 25 weeks with stroke level BP and the OB and perinatologist made the decision to take the baby by c/s immediately, to save both our lives.

So, I am greatful we have the medical knowledge to perform c-sections. I am also greatful we have the choice to deliver any way that is best for the family. Which ever way that may be.

Tina 7-03-2006 @ 3:24PM

Yes, I agree that informed choice is the most important factor. To me, the risk of rupture (1%) was too high (yes, call me wacko!) to even chance a VBAC. Rupture means the baby most likely dies, and even a 1% chance was too high for me. I'd rather take the risk myself.
As fate would have it, my dd ended up being transverse breech and way up in my uterus- my water broke the morning of my scheduled repeat c/s. We went ahead with the surgery and all was well. I can live without the accolades for giving birth the natural way- both times. I can say it never bothered me, nor did I feel like I "missed out" on anything. Luckily, I had 2 doctors who supported my choice- my body, my decision.

miche 7-21-2006 @ 3:28PM

"I can't imagine a woman choosing a vbac if there are truly risk involoved when in the end the natural birth is only what we feel not the baby."

Actually a vaginal birth is about much more than what we feel. The baby benefits from the hormones released during labor and being squeezed through the birth canal. Babies born by c-section are more likely to have breathing problems and spend time in the NICU. This statistic is for healthy babies, not babies who have an abnormality that would necessitate a NICU stay even if the baby had been born vaginally. Being fully informed of the risks also means being fully informed of the risks of a repeat c-section as well! In MOST cases VBAC is safe. Obviously every case needs to be looked at individually for risk factors.

"Rupture means the baby most likely dies, and even a 1% chance was too high for me. I'd rather take the risk myself."

I respect your choice to have a ERC, but this information is not accurate. The rate of uterine rupture is below 1% in most studies. Only the most conservative studies place it at 1%. Without induction and augmentation with prostaglandin gels and pitocin the rate is even lower. Also in these studies "rupture" is classified as ANY separation of the scar. Most times this is a minor separation and the baby and mom are fine. Henci Goer in "The Thinking Woman's Guide to a Better Birth" analyzed 29 large group studies in 1999 (newer studies have NOT shown significantly different rates) and found that scar separation or "rupture" occured in 7 or 8 per 1000 labors (0.7-0.8%) but if the large scale studies done in Los Angeles which included many Mexican immigrants are removed the rate is more like 0.4%. The reason for this is at that time most c-sections done in Mexico were with the less secure vertical incisions. Incidentally it is these Mexican immigrants we have to thank for being given the VBAC option in the first place! These low income women were literally birthing babies in the hallways waiting for OR's to open in the low income serving hospitals in the LA area back in the 70s. Doctors started looking at these women with previous c-sections delivering safetly vaginally and reconsidered the rule "once a cesarean, always a cesarean."

The perinatal mortality rate (deaths around time of birth) in the 29 large studies mentioned was 3 out of 10,000 for BOTH VBAC and planned elective cesarean groups. If "rupture means the baby most likely dies" the rate of deaths should have been similar to the 0.7-0.8% in these studies. Instead the rate was 0.03% and no greater for planned VBAC than planned ceseareans!

There is no question that the c-section rate in the US is far too high. It is now approaching 30%! The reasons for this don't make sense. If c-sections are healthier for babies why are just as many babies dying compared to the 70s when the rate was 1/3 or less! The rates of CP are also not going down. Are c-sections really safer and necessary in all or most of these cases? No! The best thing that can be done is to work to lower the primary c-section rate! I encourage all pregnant women to educate themselves to prevent an initial c-section first. Learn the pros and cons of inductions and managed labor. If you do have a c-section search for a provider who is giving VBAC a fair shot! If your doctor is hesitant search for another, even if that means changing late in pregnancy or travelling farther.

My c-section was completely unnecessary. The supposed reasons were CPD and FTP (I only went to 4cm - how can it be CPD then? Hmm?) My doctor scared me into an induction before my due date on an unfavorable cervix. SURPRISE! It failed! 14 hours after the start of induction he recommended a c-section. Hmm, coincidence that his flight for his 2 week summer vacation left in just a few hours? There was no mention of the reasons he told me for the induction in my records. Yes, my baby was 10lbs (he's now a slim, but solid tall 7 yr old at the top of the growth charts) but his head was only in the 50%, I was flat on my back, he was posterior and they turned up the pitocin so high that my contractions overlapped. I had no chance to deliver him vaginally.

Two years later I switched doctors at 32 weeks when the same doctor balked on "letting me try" for a VBAC. I had 26+ hours of active labor with slow but steady dilation and pushed out my 8.5 lb baby in 15mins. HIS head was 80% so much larger than my 10 lb baby's. The difference is I went into labor on my own (9 days post-due date) and I was allowed to stay active during labor.

Now I'm 38 weeks and had to fight AGAIN for a VBAC. This time around I have another risk factor, I'm pre-diabetic outside of pregnancy. My sugars have been tightly diet controlled to non-diabetic levels. My baby is believed to be bigger again because that's what I grow, not because of diabetes. I am travelling an hour to a small community hospital and the midwife/OB pair that are pro-VBAC (doc had one herself!) Had I stayed local I would not have a chance at a VBAC. The most VBAC friendly doctor would "let" me try for a VBAC if I went into labor on my own by 38 weeks. Had I stayed local I'd be going in Monday morning for a c-section.

As for the original post this is great news! :) Hopefully a study I'll never have to pull out to show my doctor, but if for some reasons I truly need a c-section in the upcoming weeks I'm happy to see there is a positive study on VBA2C!

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