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Vaginal Birth After Previous Cesarean Section
About Vaginal delivery after Cesarean:
Vaginal birth after cesarean section (VBAC) is an option for women who have had one or two C-sections with low transverse incisions on the uterus. VBAC has come in and out of favor over the years. In the past, after having one C-section, all future births were required to be by Cesarean.
In the 1960s, research indicated that this was not necessary, but it wasn’t until the 1980s that VBAC became more common place. In the late 1990s, the VBAC rate began to drop because of a multitude of factors including the worsening medical-legal climate (risk of doctor getting sued) and the recommendation for 24 hour in-hospital anesthesia and operating teams.
More recently, maternal mortality rates have increased in correlation with rising C-section rates. This has brought a resurgence in attention to VBAC, and to the decision-making process regarding when to perform a C-section. As all birth has risk, whether vaginal of cesarean, the National Institute of Health drafted a consensus statement on VBAC to collate the data on risks and benefits of VBAC versus repeat C-section.
Risks: VBAC vs. Repeat C-section
In one retrospective trial, the VBAC success rate was 63% for those with no prior vaginal births, 83% for those with a prior vaginal birth, and 94% for those with a prior successful VBAC. The risk to the infant with a successful VBAC is similar to that of a first-time mom delivering vaginally. In deciding between a Trial of Labor after C-section (TOLAC) or a repeat C-section, it is important to consider the risks to mom and baby, as well as the potential success rate and intended number of children as surgical risks increase with higher numbers of C-section. The table below shows the number of adverse events per 100,000 episodes of VBAC or repeat C-section.
There are clear risks to both VBAC and repeat C-section. The relative importance of each factor can only be determined by the individual woman along with her Gynecologist. With both VBAC and repeat C-section as safe choices, each woman must make a decision that is appropriate for her and her family.
VBAC is considered a women’s rights issue with the American College of Obstetrician Gynecologists. Doctors are advised to educate patients about all of their options – VBAC and repeat C-section. If a doctor individually opts to not perform VBACs, (s)he is obligated to refer to other doctors who do.
ACOG recommends that VBAC only be performed at hospitals that offer 24 hour in-hospital anesthesia coverage which limits the number of hospitals at which VBACs can be offered. Unfortunately, even in hospitals which provide 24 hour in-hospital anesthesia, many doctors refuse to allow their patients to VBAC.
The physician preference for repeat C-section is often due to the ability to schedule and quickly complete a C-section (40 minutes). VBAC usually involves spontaneously labor which can occur during the day, night or weekend, and might take 24 hours or more. The convenience, efficiency, and money earned per unit time are very influential, but should never supersede a women’s right to choose her method of delivery.
Is VBAC as a safe option?
At OBGYN North, we strongly support VBAC as a safe option for women and as their right if they so choose. As a matter of fact that there are some important reasons a mom may want to try a VBAC. First of all, Vaginal Birth offers the women the opportunity to participate fully in the delivery, also, the recovery time for VBAC is shorter because it doesn’t involve surgery and days recovering in the hospital. There is also less risk of infection and blood loss associated with c-sections. Lastly, if a family is planning for more children, pursuing a VBAC may be the right choice to avoid complications from too many c-sections.
Our statistics are similar to those quoted above, with a VBAC success rate for all patients of 81%. We are very proud of our success rate which we attribute primarily to having patience, and following the evidence-based guidelines for when a labor has truly failed to progress. OBGYn North is a safe place to haveyour VBAC. Not only because we understand the importance of having this option available for women after a Cesarean but also because we are fully equipped to offer you the best assistance and care during your VBAC.
If you are in Austin, Texas and are looking for a team of Physicians committed to providing high quality, up-to-date OB/GYN care to women from adolescence through menopause, please don’t hesitate to contact us!