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The Case for VBAC

After having a cesarean section with my first son, I knew that there would be a lot to learn before making a decision about birth options for my second son. I wanted to learn as much as I could about repeat c-sections vs. VBAC or Vaginal Birth after Cesarean. I didn’t realize how much inaccurate information was floating around about it until I went to a prenatal appointment with the one OB/GYN from the practice that delivered my oldest that I actually cared for, and saw first hand what they had to say. Most of which wasn’t educated, or evidence based information, as well as greatly outdated.

Eventually I switched providers, and got with a group of midwives with OB/GYN’s that backed them up who I still see today and decided after looking at the information that VBAC in someone like myself, a healthy low risk mother was the safest option.  While it did not work out the way I would have liked it to in the end, it didn’t make the option for VBAC any less safe since I personally was not successful.

A year later I had the opportunity to attend the National Institute of Health’s VBAC consensus via their online stream. Originally I was planning to make the trip to Maryland for the two day event, but I simply could not because of childcare, and other factors at that point in time.  I was glad that all the information that was presented was also available online, as well as all the slides presented by the panelists that shared. It was a wealth of amazing knowledge and information, and the main goal was to help the pendulum swing back to  providers recommending VBAC before elective repeat c-sections in an effort to curb the growing cesarean birth rate.

Some of the most compelling information I learned:

  • Discussion of placental problems after previous cesarean sections, and the increased risk of more serious and more dangerous placental complications with each cesarean birth.  We have seen in the past 20 years a large increase in things like placenta previa, placenta acretta, and other life threatening placental issues. Which I also highlighted last week in Cesarean Rates, Placenta Accreta and Maternal Mortality.
    Once a rare event that affected 1 in 30,000 pregnant women in the 1950s and 1960s, placenta accrete now affects 1 in 2,500 pregnancies, according to a 2007 report in the Journal of Obstetrics and Gynecology. In some hospitals, the number is as high as 1 in 522.
  • The risk of hysterectomy also increases, which is rarely discussed. The risk of having a hysterectomy with the 4th cesarean section is 2.5%.    Some interesting statistics on this are included in this post entitled After a Cesarean breaking down the numbers of hysterectomy, risk of uterine rupture, and major medical complications from repeat surgical delivery.
  • One of the quotes that stood out to me from a panel member most was… “repeat cesarean section does not eliminate the risk of fetal injury” Which is a huge common misconception of women who are opting for elective repeat cesarean deliveries, also refereed to as ERCD’s.   Which also I would like to include, many women think that you can only experience a uterine rupture (the most talked about risk of VBAC) during active labor, which is inaccurate. After any uterine surgery, a woman can experience uterine rupture any time during pregnancy, whether you are planning a VBAC or repeat c-section!
  • When comparing ERCD (repeat c-section) to VBAC, per 100,000 births, there are 9 less maternal deaths with VBAC than elective repeat cesarean delivery. Hence showing that VBAC is safer, despite all the discussion of risks.  Those are 9 mothers, sisters, daughters that can and should be saved!
  • 1 out of every 3 elective repeat cesarean deliveries takes place BEFORE 39 weeks gestation, when the recommendation is NO elective deliveries before 39 weeks. Showing that providers are picking and choosing which guidelines they want to practice.

All great information that should be widely available to all women who have had a cesarean birth. For the full text, videos, and slides from the conference itself, you can visit my personal site which has them all linked here.

Some more great websites for information on VBAC include:

http://vbacfacts.com
VBAC FAQ from The Childbirth Connection
ICAN White Papers
VBAC: The Facts

Overall, even the major medical organization ACOG (American Congress of Obstetricians and Gynecologist) agrees that women should have the option of VBAC, and in the vast majority of cases should opt for it over elective repeat cesarean sections.

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