August 18, 2007

The VBAC/repeat C-section debate

I've been debating the VBAC/repeat c-section route for myself since I got pregnant, well, actually before I was even pregnant. At this time I plan on VBAC, but every once in awhile, I start to worry and think maybe a c/s would be ok. I have done extensive research on this topic and thought I'd post some of my findings to remind myself of the advantages of a vaginal birth. These figures are from 1 source, but all sources I found report about the same figures. Uterine rupture is what causes the concern for a woman wanting to labor after having a c-section. The scar tissue is weaker and the concern is that the uterus will come apart at that scar during labor. Depending on the severity of the rupture, you worry about the outcome of the baby and mother.

1. The chance of uterine rupture with 1 uterine scar is approx .6% with a .018% perimortality rate; 2 scars= 1.8% chance of uterine rupture. These risks are similar to any other unpredictable risk of labor and delivery.

2. One study found that of 17613 VBAC's attempted, only 5 had babies who died due to a uterine rupture.

3. Vaginal birth is safer than a surgical delivery. C-Section increases risk of hemorrage, adhesions, anesthetic complications, injury to fetus, etc.

4. These increase the chance of uterine rupture: induction, pregnancy/labor less than 24 months after a c-section, classic uterine incision, age above 30.

Of course each person's case is different. I am on the low risk end. I delivered my first baby vaginally with a relatively easy labor and very little pushing time, I am under 30, it's been 3 years since my c-section, my incision was the lower uterine transvere (bikini cut), and my MD will not induce labor for a VBAC. The hospital I will deliver at requires that anesthesia and the surgeon be present during the labor (sucky for them) so that surgery can be done very rapidly if a uterine rupture occurs. I work with very comptetant nurses and have full faith that they would recognize a uterine rupture if it were to occur. Now all I have to do is hope that the little bean will cooperate and be in the head down position when the time comes in about 19 weeks!

4 comments:

Kristina said...

It is great to know that a labor and delivery nurse feels that VBAC is a safer option. Most of my education as a doula has been from the natural side, and sometimes I wonder how much the facts and studies that make it to my education are filtered to provide for a certain outcome.

Anonymous said...

i just wanted to say how glad i am to have stumbled upon your blog. my daughter was born via c-section about 2 weeks ago. she was my first, and i'm farely young, so the master plan was to deliver not just vaginally, but completely naturally. no drugs at all. unfortunately things didn't go as planned, and we had to have a c-section. not that we didn't take every step to ensure the vaginal delivery would work out, it just didn't. i definately want more kids, but my c-section didn't go well at all, and when i do have more kids, i would much prefer to try vbac, but every doctor i've asked has said they don't recomend it and my doctor even showed me the paper i would have to sign saying if i should die, or the baby should die, or both, or if this goes wrong, or that, then she is not responsible. that response from her is not very reassuring, really. but your blog really is. well, i'll be on my way. i hope you don't think me too invasive, but i'd really like to talk more about your experience and how it goes, and mine as well. if you don't mind, please write me back. i don't have an account on here, but my personal email address is sweetpitalila@aol.com i would really appreciate your imput.
-Lish

prachi said...

Hi

Would appreciate if you read my blog and suggest me if VBAC is a good option

Prachi

New Epicenter said...

Vaginal Birth After Cesarean (VBAC) provides multiple advantages over Elective Repeat Cesarean delivery, including quicker recovery, less complications, and significant decrease of risks in future pregnancies as repeat cesarean sections become more complicated with each subsequent surgery. However, when Trial of Labor fails, as happens in about 25% of the cases, an emergency cesarean is needed, which is associated with increased risks for the mother and the baby.

The choice of the best mode of delivery depends on a variety of factors, such as your history of previous deliveries, interval since last pregnancy, your age, ethnicity, health problems and more. In some cases VBAC makes more sense, and and in some cases repeat C-section is a safer option.

You can determine what option is the best for you using an app by Dr. Albert MD, "Pregnancy: Repeat C-section or VBAC?".

The app for Apple iPad is available here:
https://itunes.apple.com/us/app/pregnancy-repeat-c-section/id578140099?mt=8

The app for Windows 8 is available here:
http://apps.microsoft.com/webpdp/en-us/app/pregnancy-repeat-c-section-or/886889de-748d-483e-b1b3-cbbc58d72321/m/ROW

All the best!