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There is no evidence that routine repeat cesareans are safer than planning a VBAC. The single most controversial issue regarding birth after cesarean is the probability of a uterine rupture- the separation of the uterine scar from a prior cesarean during labor or birth. Overall studies have reported a risk of less than 1%. Yet hundreds of U.S. hospitals are no longer providing medical care for women who want to labor for a VBAC.
Risks of Planned VBAC and Repeat Cesareans
After one cesarean delivery, each additional operation puts women and babies at added risks for complications. Compared with a planned vaginal birth mothers who have a repeat cesarean are at increased risk for maternal infection, adhesions, intestinal obstruction, chronic pain, cesarean scar ectopic pregnancy, and placental problems. Placental problems from accumulating cesareans increase the risk for hemorrhage severe enough to require a blood transfusion. For the baby, scheduled cesareans increase the risk for serious neonatal respiratory problems, sometimes requiring intensive care. 1,2
1 Goer, H, Sagady Leslie, M, and Romano, A. Coalition for Improving Maternity Services: Evidence Basis for the Ten Steps of Mother-Friendly Care. Step 6: Does not routinely employ practices, procedures unsupported by scientific evidence. Journal of Perinatal Education, 2007;16(1):32S-64S.
motherfriendly.org/media.php
2 M. Silver, R, Landon, MB, Dwight JR, et al. Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries. Obstetrics & Gynecology 2006;107:1226-1232.
www.greenjournal.org/cgi/content/abstract/107/6/1226
VBAC Safety Increases with Each Additional Planned VBAC
| With no prior vaginal births |
With 1 prior VBAC |
With 2 prior VBACs |
With 3 prior VBACs |
With 4 prior VBACs |
| 63.3% |
87.6% |
90.9% |
90.6% |
91.6% |
| With no prior vaginal births |
With 1 prior VBAC |
With 2 prior VBACs |
With 3 prior VBACs |
With 4 prior VBACs |
| 0.87% |
0.45% |
0.38% |
0.54% |
0.52% |
3 Data from Mercer, BM, Gilbert, S, Mark B. Landon, MB, et al. Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstetrics & Gynecology 2008;111:285-291.
www.greenjournal.org/cgi/content/abstract/111/2/285
Compared to a routine repeat cesarean the added risk of the separation of cesarean scar is about 27 per 10,000 women who labor for a VBAC. Nearly 400 women would need to have a repeat cesarean to prevent one uterine rupture during labor. Compared to babies born by repeat cesarean delivery the added risk that a baby would die as a result of a uterine scar rupture is 1.4 per 10,000 women laboring for a VBAC. Nearly 7,100 women need to have a repeat cesarean to prevent one baby from dying as a consequence of the separation of a scar. The likelihood that a woman would die while laboring for a VBAC is less than 1 in 100,000.
childbirthconnection.org/article.asp?ck=10210
childbirthconnection.org/article.asp?ck=10166#future_birth
Do you want to contact an attorney about denial of medical care for a VBAC?
Attention:
I'm a lawyer with the Northwest Women's Law Center in Seattle. I'm
investigating possible legal responses to bans on vaginal birth after
cesarean at hospitals in the northwest states – Alaska, Idaho,
Montana, Washington and Oregon. If you are currently pregnant and
want to have a VBAC, but are facing a hospital policy that would
require you to have a c-section regardless of whether you want it and
it is medically necessary, and are willing to consider working with a
lawyer on this, we'd like to talk with you.
Please send an email to vbacbanhelp@ican-online.org and we will contact you.
For more information about which U.S. hospitals offer VBAC support, see www.ican-online.org/advocacy/home
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