Is it possible to have a vaginal birth after having a c-section?
Delivering a baby vaginally after delivering previous babies by c-section is called “vaginal delivery after c-section or VBAC.” Among the reasons women desire to deliver vaginally after a c-section are:
• Wanting to avoid the risks and long recovery of surgery
• Wanting to experience vaginal delivery
VBACs are more risky for the woman and baby than a repeat c-section according to our current studies. Studies show the most dangerous risk of VBACs is the chance that the c-section scar on the uterus will open up during labor and delivery causing a “uterine rupture.” This is a very rare occurrence, however, if it should occur, a uterine rupture is life threatening for the mother and baby. There is less than 1 percent of VBACs that lead to uterine rupture. Life-threatening situations that can occur as result of the uterine rupture are:
• Bleeding for the mother
• Brain damage or even death for the baby
The New England Journal of Medicine in 2004 published the largest and best study on VBACs. More than 30,000 women who had had a c-section and were pregnant again participated in this study. Some of the women chose to have a VBAC. Other women decided on a repeat c-section. Doctors compared the health of the women and babies after both types of delivery. The results were:
• About three-quarters (73%) of women had a successful VBAC
• The other 27% of women who tried to deliver vaginally ended up having another c-section
• Problems with the woman and baby were common among VBACs compared with repeat c-sections; however, this occurrence was rare.
• 0.8% of women had a uterine rupture
• Women who tried VBACs had more blood transfusions than those who had repeat c-sections
• Women who tried VBACs had a greater risk of endometriosis than those who had repeat c-sections.
• Babies born by VBAC had a higher risk of brain damage than those born by repeat c-section
There is a drop in the United States of VBACs. There are several reasons for this drop, which include:
• Women, doctors and hospitals are worried about the rare, yet possible problems of VBACs
• Many hospitals and doctors are banning VBACs due to fear of lawsuits that might follow VBACs that go wrong
Recommendations of the American College of Obstetricians in 2004 were:
• Hospitals have a surgical team “immediately available” whenever a woman is having a VBAC in case an emergency c-section is needed.
Many hospitals find that guaranteeing this stand-by team is too expensive. In addition, doctors are discouraging and some are refusing to perform VBACs. Reasons for this include:
• In some cases, this is because their affiliated hospital does not allow them to perform VBACs.
• In other cases, doctors are unable to get malpractice insurance to cover claims related to VBACs
• Some doctors admit they are afraid of getting sued if a VBAC results in complications
If you are considering a VBAC review the following:
• Talk to your doctor
• Read up on the subject
• You and your doctor can decide what is best for you
• VBACs and planned c-sections have their benefits and risks
• Learn the pros and cons
• Beware of possible problems that can occur before you make a decision
Recommendations of the American College of Obstetricians and Gynecologists (ACOG) for doctors to consider VBACS when:
• A woman has had 1 previous planned c-section done with a low, horizontal cut or incision called a “bikini” incision
• A woman has no other uterine scars (except for the prior c-section scar) or problems
• A woman has no known pelvis problems
• A doctor is present during all of labor and delivery to perform an emergency c-section if needed
• An anesthesiologist and other members of a surgical team are standing by in case an emergency c-section is needed
Source: National Institutes of Health Online
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. The information in this article is not intended to diagnose, treat, cure or prevent any disease. All health concerns should be addressed by a qualified health care professional.
By Connie Limon
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