Although VBAC is encouraged by ACOG and viewed by the National Institutes of Health as a reasonable option to a repeat cesarean, less than 10% of women with a prior cesarean had a VBAC in 2010. A study published in the September issue of the American Journal of Obstetrics and Gynecology suggests that care providers are not educating their patients about the benefits of VBAC and women are not making an informed decision when they elect to have a repeat cesarean section.
Researchers surveyed women with one prior cesarean birth who were being admitted at St. Luke’s Roosevelt Hospital Center in New York City to have a repeat cesarean or to labor for a VBAC. Women had already made their decision about how they wanted to give birth. The expectant mothers were surveyed between November 2010 and July 2011, after ACOG’s guidelines recommending that women receive “thorough counseling” that included the benefits and risks of VBAC.
Although the hospital has a comparatively high VBAC rate of 33%, the authors found only 13% of women who chose to have a VBAC and 4% of women who chose to have a repeat operation were aware that 60-80% of women who labor after a cesarean have a normal birth. Only one in two women who labored and one in four women who had a repeat cesarean knew that the risk of separation of the prior uterine scar was “0.5-1%.”
Of the women who had a repeat operation, more than half did not know that recovering from a repeat cesarean was longer than after a VBAC and 46% did not know that the rate of complications increases with each successive cesarean. Only half of the women knew that there is greater risk of damage to organs, excessive bleeding, and infection with an elective repeat cesarean and two thirds were not aware that an elective repeat cesarean is associated with an increased risk of maternal death, neonatal respiratory complications and admission to a neonatal intensive care unit (NICU).
Of the women who perceived that their providers favored an elective cesarean, 86% selected to have a repeat operation. Three out of four women who felt that their providers favored a VBAC chose to labor. Half the women who didn’t think their provider had a preference chose a repeat cesarean and half chose to labor. The researchers suggest that “provider bias may be affecting the opinion of some patients, with undue influence on a patient’s voluntary decision-making.”
The authors of the study, who hypothesized that current low VBAC rates were a result of poor patient education, concluded that despite the fact that this group of women represented “a better informed population,” they “showed insufficiencies in the area of comprehension, a major trend in informed consent. They lacked awareness and understanding of their situation and possibilities.”
To make an informed decision about how to give birth after a prior cesarean women need complete and accurate information about the risks and benefits of both options.
Sources of reliable information on VBAC and elective repeat cesarean.
Queensland, Australia-Center for Mother and Babies, Vaginal Birth After Cesarean (VBAC)
Optimal Birth, British Columbia, VBAC Brochure
Vermont/New Hampshire VBAC Project, VBAC Patient Education
Society of Obstetricians and Gynecologists of Canada, Vaginal Birth After Cesarean
Royal College of Obstetricians and Gynaecologists, U.K., Birth After Caeserean: Information For You