Still Hearing Scary Stories About VBAC?

11 Nov

Despite the evidence from leading maternity care associations and birth advocacy groups that planning a VBAC (vaginal birth after a cesarean) is a safe option to a routine repeat cesarean, expectant mothers with a prior cesarean are still hearing from their own care providers that VBAC is too dangerous an option to consider.

Mothers who want to avoid a routine repeat cesarean, but are experiencing resistance from their caregivers, may want to begin a conversation during their prenatal visits based on these positive VBAC perspectives:

Download from http://www.vbac.com/the-vbac-education-project/

Download from http://www.vbac.com/the-vbac-education-project/

*Women who have a trial of labor, regardless of ultimate mode of delivery, are at decreased risk of maternal mortality compared to elective repeat cesarean delivery.  National Institutes of Health

*Women who attempt a TOLAC (trial of labor after a cesarean) are successful 60-80% of the time. Vaginal birth after cesarean reduces the likelihood of maternal morbidity associated with multiple cesarean deliveries. Women who desire large families and are candidates for a TOLAC should be encouraged to attempt VBAC.  American College of Nurse-Midwives

*Women who achieve VBAC avoid major abdominal surgery, resulting in lower rates of hemorrhage, infection, and a shorter recovery period… žFor those considering larger families, VBAC may avoid potential future maternal consequences of multiple cesarean deliveries such as bowel or bladder injury, blood transfusion, hysterectomy, infection, and abnormal placentation such as placenta previa and placenta accreta. American College of Obstetricians and Gynecologists, Vaginal Birth After Previous Cesarean Delivery (August 2010, Reaffirmed 2015)

*For babies, accumulating cesarean surgeries increase the likelihood of preterm birth and subsequent complications, breathing difficulties, and admission to a NICU (special care nursery).  H. Goer and A. Romano

*Although caesarean sections are safe, research is increasingly showing that vaginal birth and labour can protect against long term-risks such as impaired immune response, asthma, obesity and type 2 diabetes in the baby. Royal College of Midwives

*Planned vaginal birth is safer overall for you than a planned repeat C-section unless there is a clear and well-supported need for a C-section. With supportive care, 75 or so out of 100 women who plan VBAC do give birth vaginally. Childbirth Connection

*Labor after cesarean is safe and appropriate for most women with a history of one or two prior cesarean births. The American Academy of Family Physicians (AAFP) recommends that clinicians counsel, encourage and facilitate planned vaginal birth after cesarean so that women can make informed decisions. If planned vaginal birth after cesarean is not locally available, then women desiring it should be offered referral to a facility and/or clinician who can offer the service. American Academy of Family Physicians

*Provided there are no contraindications, a woman with 1 previous transverse low-segment caesarean section should be offered a trial of labour after caesarean with appropriate discussion of maternal and perinatal risks and benefits. Society of Obstetricians and Gynaecologists of Canada

*There is a consensus, endorsed by evidence-based systematic reviews and clinical guidelines, that planned VBAC is a safe and appropriate mode of delivery for the majority of pregnant women with a single lower segment caesarean delivery.  National Institute for Health and Care Excellence

*Most women with a prior cesarean will give birth vaginally, including women with the following conditions: more than one prior cesarean; having had a prior cesarean for dystocia (delay in progress), macrosomia, a baby weighing more than 4000g ( 8lb. 13oz); older age; high body mass index (BMI); and longer pregnancy duration.  H. Goer and A. Romano

*TOLAC is possible for women with a previous cesarean before 37 weeks, with 2 previous cesareans, with a uterine malformation, a low vertical incision or an unknown incision, with a myomectomy, postpartum fever, an interval of less than 6 months between the last cesarean delivery and the conception of the following pregnancy, if the obstetric conditions are favorable (professional consensus). French College of Obstetricians and Gynecologists

*Unfortunately, quite a few hospitals and doctors do not support VBAC, even though the best research and professional guidelines support it in most cases. There are a number of reasons, including fear of lawsuits, insurance company restrictions and convenience of scheduled deliveries, among others. Ultimately though, the effect is the same: if you wish to use their services, you must accept surgical delivery. Childbirth Connection

*Respect for patient autonomy also argues that even if a center does not offer TOLAC, such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery. American College of Obstetricians and Gynecologists,

* Professional liability carriers and hospital administrators should not prohibit maternity care providers or facilities with maternity services from providing care to women who are candidates for a TOLAC. American College of Nurse-Midwives

*Although 70 percent of women or more who plan a vaginal birth after cesarean (VBAC) can birth vaginally and avoid the complications of repeat cesarean surgeries, almost all women today have a repeat operation because most doctors and many hospitals refuse to allow VBAC…To reduce the risk of cesarean surgery, the Coalition for Improving Maternity Services (CIMS) encourages women to seek providers and hospitals with low cesarean rates (15% or less) and those that support VBAC.   CIMS The Risks of Cesarean Section

Resources

For free, evidence-based information on VBAC for mothers, nurses, midwives, physicians, educators and doulas, download the VBAC Education Project.

The VBAC Education Project

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10 Responses to “Still Hearing Scary Stories About VBAC?”

  1. Celeste January 5, 2017 at 8:25 pm #

    How long after C-section should I wait before getting pregnant agian and trying for a vbac? I have herd 6 months, 1 year and 18 months but I figured this Web site would know best:)

    • Nicette January 9, 2017 at 6:12 pm #

      Helllo, Celeste

      The evidence shows that 18 to 24 months after the prior cesarean birth is less likely to affect the uterine scar because it has had time to heal. However, it also depends on how and with what material the scar was closed. I hove this helps. Nicette

      • Celeste January 17, 2017 at 1:00 am #

        Hello:) thank you:) so just to clarify 18 to 24 months before I could conceive ? It’s unfortunate because me and my husband would love to have a total of of 3 kids before he turns 40 which is in 3yrs at this rate not sure if it will happen. We were hoping to start trying for baby number 2 after a year however I want to try for a vbac so we will just have to wait 18 months unless 12 months is ok?

  2. Elizabeth December 11, 2016 at 9:56 am #

    Hi there, I had a c section in 2013 due to my baby being in the breech presentation. I didn’t want a c section and I was very upset over it. Now three years later I’m pregnant again. I haven’t yet been to the doctor yet but I have decided I want to try a Vbac. I want to do everything possible to increase my chances. Do you recommend getting a midwife instead of a doctor? How can I get the suppor I need to make this possible? I live in southeastern NC and I don’t see any provides that even mention vbac.

  3. Zahara December 9, 2016 at 2:04 am #

    Hello, this is amazing thanks.
    I had a cesarean in dec 2015 and I conceived 6 months after that. Here in Uganda most caregivers intentionally do cesarean due to the price since it triples the price you pay for a normal birth. I wanted to do a VBAC but in America. How should I go about it and what are the costs. Thank you

    • Nicette December 9, 2016 at 9:36 am #

      Hello, Zahara
      I’m glad you found this blog post helpful. Please, write to Nicette@vbac.com so I can answer your question. I will need to consider where in America you will give birth, what your insurance plan is or if you will pay for the services yourself, if you will consider having a doula or midwife for your birth, if you want to give birth in a hospital or a birth center, etc.. Thank you again for writing. Nicette

  4. Kristal November 23, 2016 at 9:10 am #

    I had a c-section in 1986 because the baby was really big and didn’t turn. In 1988 and 1992 I had two very easy and successful VBACs. That was in Upstate New York, but here in Ft. Myers, they refuse to do them. Many of my friends had to have C-sections.

    • Nicette November 23, 2016 at 10:19 am #

      Hello, Kristal
      Thank you for writing. This blog post was meant to provide the evidence to empower women to push for medical care for VBAC, is this is their choice.

  5. Nita November 15, 2016 at 3:25 pm #

    I have had 3 cesarean sections and would like to do a VBAC. My first c-section was emergency due to fetal distress after prolonged labor. The last two were scheduled against my wishes. How can I do a VBAC in Atlanta, GA?

    • Nicette November 15, 2016 at 8:25 pm #

      Hello, Nita
      It may be difficult to find a caregiver who will agree to a VBAC after 3 cesareans, but I suggest contacting the Atlanta Chapter of ICAN. They are a non-profit support group who know the providers in their area. You might also want to join their mothers’ discussion group. Let me know if I can do anything else to help. Here is the link for the Atlanta group, http://www.icanofatlanta.com/?page_id=273

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