Isha recently left this comment:
I am pregnant and plan on having a VBAC. I am due January 30,2011, as the day gets closer, I get more nervous about it. I hope I am making the right choice in having the VBAC.
I too wondered if it was unreasonable to plan a VBAC and that is when I started researching. I found that learning more about the risks and benefits of VBAC vs. repeat cesarean gave me a lot of peace. Check out the Quick Facts page for a brief overview and for more information, check out the information made available by the 2010 National Institutes of Health VBAC Conference.
There is about a 0.4% risk of having a uterine rupture with one prior low transverse cesarean in a spontaneous labor (meaning you weren’t induced or given pitocin or other similar drugs during your labor) (Landon, 2004). One would think that with all the hoopla about uterine rupture, that this rate would be significantly higher than other obstetrical complications. So I was really surprised to learn that uterine rupture occurs at a similar rate to other obstetrical complications such as post partum hemorrhage, cord prolapse or placental abruption! And when we look at infant outcomes, there is about a 6% chance of infant death or oxygen deprivation after an uterine rupture (Landon, 2004) compared to the 12% risk of infant death after a placental abruption (Ananth, 1999).
Yet how many of us as first time moms worried our entire pregnancies about any of those complications? How many of us considered an elective primary cesarean in an attempt to circumvent them? How many of us were offered, or even strongly pressured, to consider an elective cesarean by our friends, family, or OB? How many of us where made to feel selfish over our desire to plan a vaginal birth?
Yet moms planning a VBAC are often made to feel that having a repeat cesarean is the most prudent, conservative choice whereas only selfish women who wish to experience vaginal birth plan a VBAC. Only people who do not understand the statistics would make such a bold claim.
Just looking at the risks of VBAC isn’t enough when considering your options. One must also consider the risks of a repeat cesarean. Women planning an elective primary or repeat cesarean are probably never provided with a Cesarean Consent Form as comprehensive as this one.
I also suggest reading Another VBAC Consult Misinforms and Scare Tactics vs. Informed Consent for more discussion on how women are subtley, and sometimes not so subtley, coerced into repeat cesareans by their care providers. Additionally, check out VBAC Ban Rationale is Irrational for why the much often quoted “24/7 anesthesia requirement” doesn’t make laboring women or hospitals safer.
Most people are not aware of these facts and thus rely on the conventional wisdom and persistent rumor that VBAC is so risky and cesareans are so safe. Neither are true. Both have risks and benefits.
But when comparing the risks and benefits, both the American College of Obstetricians and Gynecologists (2010) and the National Institutes of Health (2010) have deemed VBAC a “reasonable option” for “most women” with one prior cesarean and “some women” with two prior cesareans. Most people don’t know that either.
I hope this information gives you some peace. While it’s not terribly soothing to learn that there are major, rare complications that can occur with either option, it’s also good to know that VBAC is not an excessively risky choice.
American College of Obstetricians and Gynecologists. (2010, July 21). Ob-Gyns Issue Less Restrictive VBAC Guidelines. Retrieved July 21, 2010, from ACOG: http://www.acog.org/from_home/publications/press_releases/nr07-21-10-1.cfm
American College of Obstetricians and Gynecologists. (2010). ACOG Practice Bulletin No. 115: Vaginal Birth After Previous Cesarean Delivery. Washington DC.
Ananth, C. V., Berkowitz, G. S., Savitz, D. A., & Lapinski, R. H. (1999). Placental abruption and adverse perinatal outcomes. JAMA , 282 (17), 1646-1651.
Goer, H. (n.d.). When Research is Flawed: The Safety of Planned Vaginal Birth After Cesarean. Retrieved August 23, 2010, from Lamaze International: http://www.lamaze.org/Research/WhenResearchisFlawed/VBACLandon/tabid/175/Default.aspx
Landon, M. B., Hauth, J. C., & Leveno, K. J. (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. The New England Journal of Medicine, 351, 2581-2589.
National Institutes of Health. (2010, June). Final Statement. Retrieved from NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights: http://consensus.nih.gov/2010/vbacstatement.htm