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Repeat C-Section or Vaginal Birth After Cesarean?

With the new revaluation that repeat c-sections are driving up the cesarean section rates across the country, it brings up the age old question… Is VBAC (vaginal birth after cesarean) safe?

The answer to that question is YES! In healthy, low risk women with no complications it is the safest option after having a previous cesarean delivery.

Unfortunately because of the number of women having repeat c-sections, the true information and statistics surrounding vaginal birth after cesarean are being swept under the rug, and not given to patients by their providers.

Dr. Stuart Fischbein takes it on in this youtube video:

Some of the risk related statistics I find most helpful for making an informed decision about VBAC are:

1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)

1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion’s : 21.6% (1 in 5)

2nd VBAC
Chance of Successful VBAC : 87.6% (9 in 10)
Risk of Uterine Rupture : 0.45% (1 in 222)
Risk of Hysterectomy : 0.17% (1 in 588)
Risk of Blood Transfusion : 1.24% (1 in 81)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion’s : 32.2% (1 in 3)

3rd VBAC
Chance of Successful VBAC : 90.9% (9 in 10)
Risk of Uterine Rupture : 0.38% (1 in 263)
Risk of Hysterectomy : 0.06% (1 in 1667)
Risk of Blood Transfusion : 0.99% (1 in 101)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in 8)
Risk of Dense Adhesion’s : 42.2% (2 in 5)

Note : “Major complications” include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.

This is all great information that all women should know when making the choice of how they want to birth after having a cesarean birth.

I hope that some mothers with previous cesareans can truly benefit from this information!

 

Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.

Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveres. Obstetrics & Gynecology 2006; 108: 21-6

Thinking about a C-section? 10 Things you should know

Article Posted 4 years Ago
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