VBAC vs C-Section: The Facts

When it comes to VBAC vs c-section?

Which is better?

Which is safer?

Does it matter?

Lots of questions.

First of all what is a vbac?

A VBAC – Vaginal Birth After C-section – has become very controversial and less and less doctors are willing to “let” mothers labor after they have had a c-section. As a matter of fact, the stance of ACOG – American College of Obstetricians and Gynecologists – is against them. ACOG still adheres to “once a c-section always a c-section.”*** Considering that right now in the USA, over 1/3 of births end in c-sections, this has dire consequences for the mothers who do not want another surgical birth.

***In 2010, ACOG changed its guidelines about VBACs:

acog's guidelines for VBAC

 

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If you want a VBAC then you need the facts, the truth and nothing but so that YOU can make the best decision for you and your baby instead of being coerced into something you do not want.

 

VBAC vs C-Section

Is a VBAC Dangerous?

Even though ACOG’s recommendations have changed many  OBGYNs will try to sway women away from a VBAC. Why?  Few people – if ever – sue for a c-section and through fear tactics many moms will decide to have a repeat c-section.

To those educated about the facts – midwives and doctors alike – a VBAC is still a safer option than major abdominal surgery.

This is not just our opinion…Doctor Bruce Flamm – an MD – in his book “Birth After Cesarean: The Medical Facts” states:

“Women wanting a VBAC ‘have been erroneously told that they are in a very high-risk group.’”

He also states that:

“the chance that a VBAC candidate will require emergency surgery is, for all practical purposes, no higher than that of any other pregnant woman.”

If this wasn’t enough he added:

“the risk of VBAC is not substantially greater than the risk of any type of childbirth.”

What about a VBAC with a midwife rather than a doctor?

Dr. Flamm answers this question as well:

“Midwives generally give care to low-risk or ‘normal’ pregnant women. However, VBAC mothers are not excluded. Numerous medical reports have revealed that VBAC is not associated with substantially more risk than any other childbirth.”

VBAC vs C-Section

A VBAC Is Safe

In a December 2004, a study about VBAC was released:

“Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery” by Mark Landon, M.D.

This study – which compared the outcomes for VBACs as well as elective (unnecessary) repeat c-sections (also referred to as ERCS) – is very important because the control group was substantial enough that the findings can and should be taken seriously.

When uterine ruptures occur as infrequently as they do, a large sample is necessary to accurately catalog the findings. Of note, any study which does not compare the risks of a vbac to the risk of a repeat c-section can be disregarded for they are biased and of no value. Both VBACs and c-sections have risks and in order for you to make a decision you must be aware of the both sides of the risks and benefits.

Anything but the whole truth – and nothing but – is not truth but a version of it. Wouldn’t you agree?

For this reason the researchers looked at over 18,000 Southern California women.

RESULTS

Vaginal delivery was attempted by 17,898 women, and 15,801 women underwent elective repeated cesarean delivery without labor. Symptomatic uterine rupture occurred in 124 women who underwent a trial of labor (0.7 percent). Hypoxic–ischemic encephalopathy occurred in no infants whose mothers underwent elective repeated cesarean delivery and in 12 infants born at term whose mothers underwent a trial of labor (P<0.001). Seven of these cases of hypoxic–ischemic encephalopathy followed uterine rupture (absolute risk, 0.46 per 1000 women at term undergoing a trial of labor), including two neonatal deaths. The rate of endometritis was higher in women undergoing a trial of labor than in women undergoing repeated elective cesarean delivery (2.9 percent vs. 1.8 percent), as was the rate of blood transfusion (1.7 percent vs. 1.0 percent). The frequency of hysterectomy and of maternal death did not differ significantly between groups (0.2 percent vs. 0.3 percent, and 0.02 percent vs. 0.04 percent, respectively).

 

CONCLUSIONS

A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low. This information is relevant for counseling women about their choices after a cesarean section.

 

Now let’s talk, uterine rupture…

 

The Big R Word: Rupture

Before we go any further we need to talk about the only true risk about a VBAC…uterine rupture.

Is it likely?

How often does it happen?

Talking about uterine rupture in general is not a good way to go…there are many factors to consider first:

  • Was labor induced?

    Some studies show that almost half of all births are induced – started with drugs such as pitocin or cytotec – or augmented – contractions increased with the use of medication usually pitocin.

    If an induction or an augmentation occur, even women who have not had a previous c-section have a higher risk of uterine rupture.

    Sadly, most studies on uterine rupture do not make the distinction as to whether a birth was induced – or augmented – or whether the labor was spontaneous – started on its own. Women need to know the true risks and all the factor involved…not just some random numbers which increase the fear without giving all the true facts.

     

  • What type of scar do you have?

Is it a classical cut – which is vertical?

An inverted T?

Or is it the most common…a bikini cut – horizontal?

Note:  It is true that the classic cut and the inverted T have a higher rate of rupture than the bikini cut.

 

VBAC vs C-Section: What Is A Rupture Exactly?

If you have a rupture you and your baby will die.

A True Uterine Rupture

A true uterine rupture – also called a true rupture – is usually sudden and will usually produce a lot of pain. There will also be blood loss and there could be the death of the baby.

It usually happens to an unscarred uterus and it is traumatic and sudden. It also occurs with a classic uterine scar from a previous c-section.

According to ACOG, the rate of true uterine rupture involving a bikini cut – horizontal/transverse scar – is said to be between .2 to 1.5 percent so this would involve 1 out of 67 to 500 women.

Another study done by Drs. Toppengerh and Block and involving more than 130,000 report rates that average 0.6 percent.

 

An Incomplete Rupture

An incomplete rupture – also called a uterine dehiscence – usually has no symptoms. It is rarely fatal to either mom or baby.

So your risk of a rupture is minimal…especially if you start labor on your own and receive no drug to augment it. Most times such a rupture is so insignificant that it goes unnoticed by the medical staff.

For a list of cesarean complications Click Here.

Ultimately, YOU should get to decide AFTER looking at the facts, what is best for you and for your baby not a doctor in a white coat, who will not live with the consequences of that choice and NEVER should you be frightened into a decision because this is no longer informed consent.

 

Happy birthing!

 

Further Reading about VBACS:

 

 

Sources and further reading for VBAC vs C-Section:

  • “OBGYN Secrets” by Wilkins-Haug & Fredrickson. Section 77 VBAC by Robert Silver MD.
  • “Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery” by Mark Landon, M.D.
  • “Uterine Rupture: What Family Physicians Need to Know” by Kevin S. Toppenberh, M.D., and William A. Block, JR., M.D.
  • Birth After Cesarean: The Medical Facts by Bruce L. Flamm
  • http://vbacfacts.com/quick-facts/
  • Fang (2006) which was a overview of the VBAC research to date concluded, “Because repeat cesarean deliveries are performed largely to benefit the neonate, clinicians may often overlook maternal complications resulting in significant morbidity and even mortality as a result of repeated surgeries… Because neither VBAC nor elective repeat cesarean delivery is without maternal and neonatal risks, VBAC should remain a viable option for clinicians and patients in the new millennium. Vaginal birth should not become a relic of the 20th century!”
  • Mankuta (2003) “favors a trial of labor if it has a chance of success of 50% or above and if the wish for additional pregnancies after a cesarean section is estimated at near 10% to 20% or above because the delayed risks from a repeated cesarean section are greater than its immediate benefit.”
  • Rageth (1999), a study of 29,000 women, confirmed, “A history of cesarean delivery significantly elevates the risks for mother and child in future deliveries. Nonetheless, a trial of labor after previous cesarean is safe. Induction of labor, epidural anesthesia, failure to progress, and abnormal fetal heart rate pattern are all associated with failure of a trial of labor and uterine rupture.”
  • Silver (2006) was a four year study of 30,000 women undergoing up to six repeat cesareans determined, “Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.”
  • Mercer (2008), a study of 13,532 women found, “An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.”
  • https://www.acog.org/~/media/ACOG%20Today/acogToday0810.pdf?dmc=1&ts=20140604T1103087009
  • http://www.nejm.org/doi/full/10.1056/NEJMoa040405
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