Long Facts
Note 7/25/10 – This page contains a lot of detail. If you are looking for an overview of VBAC vs. repeat cesarean, please visit the Quick Facts page. After you read that, if you want more information, come back here.
“As long as you are of legal age and able to think clearly, logically, and coherently for yourself, you should never cede that responsibility [to make your own health decisions] to anyone else – not your doctor, not your friends, not to your family, not to the heath gurus, and especially not the media. Unlike many among the health police force, I believe that you are easily smart enough to evaluate the news. You really have no choice. People are finally realizing that they cannot trust the health industry machine anymore. That means you must come to rational, intelligent decision based on the best that science has to offer” – From Eat, Drink, & Be Merry by Dean Edell, MD
Don’t Freak, Know the Facts
Note: In this article, I reference frequently the landmark December 2004 VBAC study, Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery by Mark Landon, M.D., because it is the largest case control study completed comparing the outcomes of VBAC and elective repeat cesarean section (ERCS.) The study included over 18,000 women in Southern California. This is important because in order to document the occurrence of an event that happens as rarely as uterine rupture, large numbers of VBACing women must be included in studies in order to get the most accurate measurement. Other studies such as Risk of Uterine Rupture During Labor Among Women With a Prior Cesarean Delivery (Lyndon-Rochelle 2001) includes large numbers of VBACing women, over 20,000, but does not compare the outcomes to cesarean section. It’s one thing to identify and quantify the risks with VBAC, but those risks must be weighed against the risks associated with surgical birth as the mother only has those two options. In order to select the safest option for herself and her infant, she needs to understand the risks and benefits of surgery just as she understands the risks and benefits of VBAC.
There is so much information out there about VBACs – I won’t regurgitate it all here. Rather, I’ll give a brief overview on VBACs, the risks, and the ironies that exist in medicine. It is very important to base your opinions and actions on facts rather than fear. It is easy to let fear dictate your life, but that is a miserable way to live. Why not know the risk, how you can reduce the risk, and plan accordingly?
Are VBACs High Risk? Quite simply, no. Bruce Flamm, MD states in Birth After Cesarean: The Medical Facts
Factors for rupture. There are a few things to consider in terms of VBAC – type of scar, labor induction, and types of uterine rupture. VBACs have historically received a bad rap because of the methods of incision that were originally used for cesarean sections, such as the classical and inverted T, have higher rates of rupture than the low transverse (bikini cut) method. 40% of births in American are induced and women who have been induced or have had their labor augmented through the use of drugs to stimulate contractions and ripen the cervix, experience an increased risk of rupture including women who have unscarred uteri. Studies that measure the rate of uterine rupture rarely distinguish between true uterine rupture and uterine dehiscence which gives the medical community and public at large an inflated, inaccurate estimate of risk.
To accurately asses the risk of VBAC, it is necessary to differentiate between complete or true uterine rupture and incomplete rupture, often termed occult rupture or uterine dehiscence. True uterine rupture is often sudden and associated with pain, blood loss and fetal morbidity. It is most commonly seen in spontaneous or traumatic rupture of the unscarred uterus. It also has been associated with classic uterine scars, often occurring without labor. Conversely, uterine dehiscence is partial separation of the uterine wall that is usually asymptomatic and rarely contributes to fetal or maternal morbidity. This is often the type of separation seen in lower segment scars, and usually occurs during labor. Often asymptomatic windows are incidentally noted at the time of repeat cesarean section. (From OB/GYN Secrets by Wilkins-Haug & Fredrickson. Section 77 VBAC by Robert Silver MD.)
True uterine rupture is typically distinguished from asymptomatic scar separation (dehiscence) by the need for emergency surgery, although some reports combine these separate processes and confuse the statistics. The rate of true uterine rupture with one prior low-transverse scar has been reported by ACOG to be between 0.2 and 1.5 percent (one of 67 to 500 women). Other studies involving more than 130,000 women undergoing a trial of labor for VBAC report rates that average 0.6 percent (approximately one of every 170 women). (Toppenberg 2002)
So, when you hear of uterine rupture, whether it’s a study or an individual woman, it’s important to ask what type of scare, was labor induced or augmented with drugs, and was it a true uterine rupture? It is important to have facts rather than just freak out because an OB tells you that it’s to risky.
Rates of Rupture: VBAC vs ERCS. There are a couple things to consider when looking at uterine rupture. First, understand that if you schedule an elective repeat cesarean section (ERCS), you are not protecting yourself from uterine rupture. While the rates of rupture among women who do not experience labor and opt for a ERCS are lower, they expose themselves to the additional risks associated with surgery. This is supported by Mozerkewich 2000 (VBAC 0.4% vs. ERCS 0.2%), Korst 1999 (VBAC 0.53% vs ERCS 0.28%), and Lyndon-Rochelle 2001 (VBAC 0.6% vs ERCS 0.16%).
Rates of Rupture: Spontaneous vs. Induced/Augmented Labors. When attempting to approximate your risk for uterine rupture, it’s important to differentiate between spontaneous and induced/augmented labors. Landon 2004 featured the VBAC labors of almost 18,000 women and found varying rates of rupture based on spontaneous vs. augmented vs. induced labors.
Spontaneous means that labor starts on its own. Induced means that the laboring mom is given drugs, usually Pitocin, Cyotec, and Cervidil, to start labor. Augmented means that the laboring mom is given drugs during labor, usually to speed things up or to restart a “stalled” labor. Specifically, they found the following rates of uterine rupture: 0.4% (N = 24) in spontaneous labors, 0.9% (N = 52) for augmented labors and 1.0% (N = 49) for induced labors.
They further broke out rupture rates by type of induction: 1.4% (N = 13) with any prostaglandins (with or without oxytocin), 0% with prostaglandins alone, 0.9% (n = 15) with no prostaglandins (includes mechanical dilation with or without oxytocin), and 1.1% (N = 20) with oxytocin alone. Overall, they found 0.7% of women experienced a true uterine rupture with an additional 0.7% experiencing a dehiscence. Lyndon-Rochelle 2001 found that women with spontaneous labors had a rupture rate of 5.2 per 1000 (0.52%) while labors induced without prostaglandins (7.7 per 1000, 0.77%) and labors induced with prostaglandins (24.5 per 1000, .24%) experienced rupture rates 4.7 times and 1.5 times higher respectively.
I find it bizarre that multiple studies have found drug induced labors result in more ruptures, yet OBs go on inducing. If OBs are so concerned about uterine rupture, why do they continue to induce VBACing women, especially with prostaglandins (misoprostol aka Cytotec and dinoprostone aka Cervidil), which are the most risky labor inducing agents to use in a VBAC labor?
Oxytocin (Pitocin) is widely used, so it is not surprising that this uterine stimulant has been administered in a majority of ruptures. One center found that oxytocin had been given in 77 percent of their ruptures and was typically used to stimulate labor in women with a prolonged latent phase. Misuse of oxytocin carries significant risks in any mother, and this risk may be increased during VBAC, especially at high infusion rates. ACOG guidelines and other authors indicate that oxytocin use during VBAC is acceptable. Induction of labor, regardless of the method used, is increasingly recognized as a risk factor for uterine rupture. Recent VBAC studies have shown three to five times more ruptures among induced mothers compared with those having spontaneous onset of labor. (Toppenberg 2002)
In 2005, another study concluded “in women with previous caesarean section and no vaginal deliveries, induction of labour carries a relatively high risk of uterine rupture/dehiscence despite all precautions, including intrauterine pressure monitoring.” (Kayani 2005) Landon 2004 found that inducing or augmenting labor resulted in a doubling of the uterine rupture rate and Kayani concurs a year later.
Why don’t they wait for labor to spontaneously being? As long as mom, baby, and placenta are fine, there is no reason to be inducing. We know from Dr. Wagner’s book “Born in the USA,” that 40% of women in the US are induced. We know that 40% of birthing women are not “high-risk,” so why all the inductions?
It’s because most OBs do not practice evidence-based medicine and there are other factors, such as convenience, which dictate their actions. It is hard to rectify a medical community that says VBAC is to risky to permit on one hand, but electively increases that risk through induction. Baring true medical complications – baby being “to big” and going “overdue” are NOT true medical complications – a woman should wait until 42 weeks for spontaneous labor.
“Medical studies have shown that the most common reason for a baby being ‘overdue’ is not that mother nature has made a mistake but rather that we have made a mistake in calculating the due date.” (Flamm, Birth After Cesarean) Size estimates based on ultrasounds are notoriously inaccurate (see Yagel 1986, Egley 1986, and Yeh 1982) and since most women do not have 28 day cycles, due dates are pretty useless (which is why it is important to chart.) If a mom really needs to be induced, there are non-drug methods of induction that are certainly worth a try, but all induction does is increase your risk for a cesarean section. It’s just not worth the risk unless you or your baby have some medical reason that birth must happen sooner rather than later, which is rare.
As a member of ICAN, I hear story after story of women whose primary cesarean section was performed due to “big baby” and then went onto VBAC a larger baby as well as women who really trusted their OB with their first baby and agreed to an induction, without a true medical reason, only to end up with “failure to progress” and sectioned. You will know when your body and your baby are ready for labor because labor will begin. Trying to force your body to birth will result in a more painful labor and an increased likelihood that your labor will end with a surgical birth. If you think waiting for labor to start is hard, consider recovering from major abdominal surgery and caring for a newborn. Take it from me – IT SUCKS! The fact is, the medical community has completely lost faith in a woman’s ability to birth without prodding and pushing through interventions, drugs, and timelines.
Infant Outcomes. In terms of infant outcomes, I again refer to the Landon 2004 study which found:
Overall, our data suggest a risk of an adverse perinatal [pertaining to the period immediately before and after birth] outcome at term among women with a previous cesarean delivery of approximately 1 in 2000 trials of labor (0.46 per 1000), a risk that is quantitatively small but greater than associated with elective repeated cesarean delivery.
In other words, while the rate of uterine rupture in a spontaneous labor with one prior cesarean is approximately 1 in 250 (0.4%), 1 in 2000 (0.05%) VBAC babies will have a bad outcome.
In Table 6 entitled “Perinatal Outcomes After Uterine Rupture in Term Pregnancies” they stated that from 114 ruptures at term, 7 (6.2%) babies had hypoxic-ischemicencephalopathy (brain damage), 2 (1.8%) died, 46 (40.4%) were admitted to the NICU, 16 (14.0%) had 5-minute apgar scores less than or equal to 5 and 23 (33.3%) had umbilical artery blood pH less than or equal to 7.0. So, there was a “bad outcome” for VBAC babies in 1 out of 2000 trials of labor. That’s a very small number. So, the risk to your baby is low.
Lyndon-Rochelle 2001 found that while 5 out of 13,115 babies (0.04%) died as a result of uterine rupture, 100 out of 20,004 babies (0.5%) died for other reasons. The mothers of those 100 babies did not rupture. Babies had a 10 times greater risk of dying for reasons other than uterine rupture. Mozerkewich 2000 found little difference between VBAC and ERCS fetal deaths, 0.2% (38 of 19,842) vs. 0.1% (10 of 13,292).
VBAC is safe for babies and Lyndon-Rochelle suggests that babies are far less likely to die from uterine rupture than they are from other labor complications.
Maternal Outcomes. Landon 2004 found that 5.5% of women (978) who had a trial of labor had complications. The most common occurring complications were endometritis, an inflammation of the endometrial lining of the uterus, (217 women, 2.9%) and blood transfusion (304 women, 1.7%) with uterine rupture (124 women, 0.7%) and uterine dehiscence (119 women, 0.7%) tied for last. The three least common complications were maternal death (3 women, 0.02%), thromboembolic disease, including deep venous thrombosis or pulmonary embolism (7 women, 0.04%) and hysterectomy (41 women, 0.2%.) Counter this with the complications experienced by women undergoing an elective repeat cesarean. Overall complication rate was 3.6% (563 women.) Top three complications were endometritis (285 women, 1.8%), blood transfusion (158 women, 1.0%), uterine dehiscence (76 women, 0.5%.) The bottom three complications were uterine rupture (0 women), maternal death (7 women, 0.04%), and thromboembolic disease (10 women, 0.1%.)
Risks of Cesarean. How is it that when most OBs hear of a woman’s desire to VBAC, they immediately pull out the “your uterus will explode” card and yet, they are remiss in listing all the risks involved with a cesarean? As we have already established how ERCS does not protect you from rupture, I find that a little one-sided and I question any OB who will waive a 0.5% risk in your face while remaining silent on the also very real, risks, associated with cesareans. Please read Comparing the Risks: VBAC versus Repeat Cesarean Section for more information.
Banning VBACs. Based on the most recent evidence, in March 2005 the American Academy of Family Physicians (AAFP) revised its VBAC guidelines and now encourages women to consider labor after a prior cesarean and maternity care providers to support women’s choice. The AAFP found no scientific evidence that having a surgical team and anesthesia “immediately available” when a VBAC mom labors to significantly improved outcomes. The complete guidelines are available as a pdf file from the AAFP web site.
I personally would not feel safe at a hospital that does not permit VBACs, whether my uterus was scarred or not. If they cannot accommodate a medical emergency such as uterine rupture, how could they possibly respond and treat other real, but rare, labor emergencies such as cord prolapse or placental abruption, both of which require the baby being born ASAP usually by immediate cesarean sections? We know that babies have a 10 times greater risk of dying for reasons other than uterine rupture. (Lyndon-Rochelle 2001) How could any mother labor in confidence knowing that if something went drastically wrong, that hospital could not quickly respond? At which point, why even go to a hospital? I always thought that was the point of hospitals in terms of birth – to treat the very rare complications that require immediate surgical intervention. If hospitals eliminate their ability to rapidly respond to a medical emergency requiring a surgical birth, how is laboring at a hospital like that any different than laboring at home? People labor in the hospital for that minute “what if” chance thinking that they will be safe. Thinking that laboring at a hospital is safer than home. But if a hospital labels itself as non-VBAC friendly, they have labeled themselves unsafe for any laboring woman. Hospitals which do not permit VBACs are unsafe to all women and laboring women should avoid them. We need to send a message with our money and our babies by only laboring at VBAC-friendly hospitals or electing to birth at home.
Symptoms of Rupture. It is also important if you wish to VBAC to understand the symptoms of uterine rupture.
* Extreme pain (may or may not be felt through epidural, though it usually is because of it’s severity)
* Bulge in the abdomen (where the baby may be sticking through uterus)
* Excessive bleeding
* Shoulder pain
* Loss of baby’s station
* Cessation of labor
* Heart decels in baby
The thing that remains constant in the bulk of the rupture stories I have read is this: the laboring woman knew something was wrong, but that is not always the case. It is so important to listen to your instincts and make other people, especially medical personnel in the face of their machines saying everything is just dandy, listen to you. I know hospitals are busy and L&D nurses are busy and those EFM are so helpful in permitting them to “care” for multiple patients at one time. But it seems that as soon as that belt is ratcheted on your pulsing tummy, you, as the laboring mom, have become just a wee bit invisible. Now they have the smart machines to tell them how you are doing. And somehow, your experience, your instinct, is relegated to the opinions of a lay woman in labor, which are not held in the same regard as the long ticker tape bursting forth from the EFM. Make them listen. If your instinct is telling you something is wrong, listen. Labor is ancient. Your instincts are ancient. Tap into that and use it. Use that knowledge that has been hard-wired into our brains. There is a reason why it is there. We all have the instinct to survive and if you feel that something is wrong, really wrong, it probably is. All you have to do is read the stories of women who have experienced a rupture, only to be surrounded by medical professionals who didn’t recognize the symptoms in time to save their baby, to know that it is your obligation as a VBACing woman to know the signs. Again, you must do the research, you must know the facts. Do not rely on your OB, the hospital, the L&D nurses, or that lovely external fetal monitoring machine. The knowledge you acquire is your first line of defense and you are naive if you think otherwise. You are also naive if you think any machine can identify a rupture faster and more accurately than the careful observation of a knowledgeable human being.
Scheduling Cesareans. I personally believe that OBs like to schedule cesarean sections rather than grant a woman a trial of labor because it’s convenient, they are under the misguided notion that they are in control, and, if anything goes wrong, they have already performed the ultimate intervention, so how could anyone find fault?. I understand that it’s easier for OBs to schedule a cesarean section rather than being called in at 4am like my OB. I also know that between the OBs, anestheologists, and hospital charges from the surgery and recovery, everyone involved makes more money. My insurance was billed for over $22,000. “Financial cost (as measured by hospital charges) of cesarean delivery was 1.66 to 2.4 times greater than the cost of vaginal birth.”
But I think the tipping point is control. When a woman is in labor, no one person is in control. The human body knows how to labor. It does not require any assistance. There is little regard for the subtle, unseen hormonal and chemical changes within the laboring women’s body that guide labor and delivery. OBs try to induce labor when the body is not ready, or try to augment it when the body is moving “to slow,” and then try to reduce pain when the induced/augmented contractions are stronger and more frequent than naturally occurring contractions. The OB tries to manage the labor, but the fact is, the woman’s body is in control. The OB does not know how long this particular woman will labor. The OB does not know how quickly she will dilate. There are so many unknowns because every labor is different in terms of length, speed, pain, etc and no matter how many models and charts are created, there is no accurate way to predict. There is so much that is unknown to the OB. Compare that to a cesarean section. The OB is the one cutting, the OB is in control. There is this false sense that less can go wrong because the baby is no longer dependant on the unpredictable human body. With a few cuts, the baby is born.
The cesarean section is an incredible surgery that saves lives, but the unfortunate fact is that most cesarean sections are performed unnecessarily and expose mother and baby to an unnecessary level of risk.
Whatever you decide, I encourage you to read, learn, and base your informed decision on facts. It is also important for you to be aware of your patient rights and exercise them if necessary.
Questions to Ask: How to Find a Truly VBAC Supportive OB/Midwife
Has been moved here.
Comparing the Risks: VBAC versus Repeat Cesarean Section .
I give a complete comparison in my VBAC Class and just haven’t had a chance to type it all up for the site. Below is a brief summary and many links to excellent references. Also, be sure to read the VBAC Class Bibliography.
When comparing the risks of VBAC vs ERCS (elective repeat cesarean section), the risks are essentially this: the risk of a “normal” vaginal birth plus uterine rupture vs. the risks of surgery to mom and baby and future complications caused by cesarean surgery.
“Both vaginal birth after cesarean and repeat c-section involve some increased risks to mothers. However, without a clear, compelling and well-supported need for c-section in the present pregnancy, planned vaginal birth is safer overall for you than a planned repeat c-section.” From Options: VBAC or Repeat C-Section Childbirth Connection
“In fact, looking at just the excess reproductive risks: infertility, ectopic pregnancy, stillbirth, preterm labor, small for gestational age, malformation, central nervous system injury, it becomes clear that the scarred uterus and the presence of surgical adhesions make a much less hospitable environment for nurturing future babies.” From Elective Cesarean Surgery Versus Planned Vaginal Birth: What Are the Consequences published by Lamaze International
Read a lot… you can start here:
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What Every Pregnant Woman Needs to Know About Cesarean Section published by Childbirth Connection
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Best Evidence: VBAC vs Repeat C-Section published by Childbirth Connection
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Elective Cesarean Surgery Versus Planned Vaginal Birth: What Are the Consequences published by Lamaze International
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Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol. 2006 Dec;195(6):1538-43. Epub 2006 Jul 17.
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Caesarean delivery and risk of stillbirth in subsequent pregnancy: a retrospective cohort study in an English population. BJOG. 2007 Mar;114(3):264-70. Epub 2007 Jan 22.
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Is planned cesarean childbirth a safe alternative? CMAJ. February 13, 2007; 176 (4)
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Chauhan SP, Martin JN Jr, Henrichs CE, Morrison JC, Magann EF. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: a review of the literature. Am J Obstet Gynecol 2003;189:408-417. [CrossRef][ISI][Medline]
Key Factors in VBAC Success
In all the reading and research I have done, there are a few behaviors that continually reappear among women who achieve VBACs. This is not scientific, just anecdotal.
Philosophy:
A woman who accepts her personal responsibility in her own health care by educating herself while believing in her body’s ability to give birth.
Behaviors:
- Supportive husband
- Educated herself
- Supportive care provider
- No drugs whatsoever
- Refused induction
- Refused rupture of membranes
- Stayed ACTIVE and changed positions the entire labor
- Ate and drank as she wanted to
- Remained completely relaxed and therefore had plenty of energy
- TRUSTED HER BODY!
ACOG on VBAC
- 2004 ACOG Practice Bulletin, No. 54
- Vaginal Birth After Cesarean in California: Before and After a Change in Guidelines, 2006
- 1999 ACOG Practice Bulletin, No. 5 – Summary
- 1999 ACOG Practice Bulletin, No. 5 – Full Text
- Critique of ACOG Anti-VBAC Practice Bulletin No. 5, July 1999
- 1995 ACOG VBAC Guidelines
You’ve put together a great website here! Thank you for all the hard work.
You have a great HBAC story as well. I’m so glad it went well. I had 2 hospital births (good) followed by 2 homebirths (AWESOME), so I know how homebirth goes.
I find that study on VBAC with limited use of induction very compelling! Such a low rupture rate. I’d love to know if that mom had Pitocin at any point. On the Pitocin issue though–while 20 mU/min is “limiting” the Pitocin as compared to other protocols that can have it over 30 mU/min (highest I’ve seen as a doula is 32 mU/min), I have to point out that it isn’t, by a long shot, “low dose.”
The package insert for Pitocin says that 6 mU/min is equivalent to normal labor, and that levels above 10 mU/min are “rarely needed.”
A true “low dose” protocol for Pitocin would involve following the package insert at the very least. That is, starting the dose at 0.5 to 1 mU/min, raising it in 30 to 60 minute intervals at no more than 1-2 mU/min increments. What I typically see is the dose starting at 2 mU/min and being raised 2 mU/min every 15 minutes. I have also seen it DOUBLED every 15 minutes–so by 60 minutes the mom was getting 16 mU/min–nearly 3 times the strength of natural labor! She dialated from 4-10 in 1 hr 45 minutes. When I went out to the nurses’ station to comment to the medwife that my client was having difficulty with the contractions, she said to me “this is what labor is.” I’d had 3 babies by that point–none with Pitocin–so I most certainly knew that was NOT what labor needed to be!
Oh, and also…the regular external fetal monitor will work with a mom out of bed, she is just tethered. Regardless, I agree that constant fetal monitoring is for the birds!
i found both the bquestions in regards to VBAC were very helpful and informative!!!
Great material on VBAC. Is ther any stats on trialof labor after more than one c-section? If so can you please post and send the info to me. Thanks.
[...] work for me after all, how about Wed?). Here’s a great website to learn more about VBACs: VBAC Facts
The info was so informative. My first section was due to the big baby theory. My second just because i had one prior section. My third because of placenta previa so they say but the entire pregnancy they were telling me there were no problems. I could VBA2C but when the time came i was whisked to the OR so fast i had no time to react. Now with my fourth I am standing up speaking out since I have done my homework there will be a VBA3C.
sharee,
I was curious to know how your VBC3C turned out…
I am currently contemplating a VBA2C and am weighing all the pros/cons and was just curious as to how you made out since you’ve had 1 more CS than I
thanks for your input
cat
Very comprehensive website on VBACs … wish I had found it before attempting mine. Although I haven’t fact-checked all of your research, it sounds pretty consistent with what I’ve seen. Just wanted to provide you with another perspective. At 38 wks into my 2nd pregnancy, I spontaneously went into labor at about 4:15 in the morning. By 5 am, I was in the operating room for an emergency c-section where they discovered I had a complete uterine rupture. I had NO risk factors for rupture … I’m relatively young, low transverse scar, easy pregnancy, baby was 7 lbs 6 oz, 38 wks, no drugs whatsoever, only 1 previous pregnancy, almost 3 years prior, etc. I also had no classic symptoms of rupture when I arrived at the hospital (pain, bleeding, etc). I was just extremely lucky that a very experienced OB was attending at the hospital when I arrived (he didn’t like my baby’s heartrate tracing and sent me immediately to the operating room) … he saved both my life and that of my son.
I know that the risk of rupture is very very low, especially given my risk factors, and if I had to do it over again, I’d still take my chances with a VBAC. But having been that “1 in a million”, I’m really glad I was so close to a major teaching hospital that specializes in high risk births.
Susan, Thank you so much for posting and I’m so thankful that you and your baby survived! I can’t imagine how scary! I think the fact that you ruptured and still support VBAC speaks volumes. Best, Jen
I had my first child through viginal birth,I however miscarried the second when i was 3months gone due to uterine fibroid.six weeks later i had a c.s to remove the fibroid and now six months on i am about twenty weeks gone with my third pregnancy. what are my chances of having a normal viginal birth
Afua, I am not a medical professional, so I recommend you interview several VBAC supportive OBs, hospital midwives, (and homebirth midwives if you are considering homebirth) to get multiple opinions. Get a copy of your surgical report and bring it with you. Go here more info on how to find an OB/midwife and here for questions to ask them. Best of luck, Jen
i had my first child a year ago through a c.s and i am now 40week gone with my second preg and the doc want to perform a another c.s on me but i really want to try vaginal delivery.i am however frightened the unexpected may happen if i insist on vbac what do u recommend
Cyndy – I’m so sorry you are experiencing this. Was your OB initially supportive? If so, many women have experienced this “bait and switch“. You can go into labor and decline, decline, decline, like this woman. It’s hard though because how can you trust your OB when they say “Your baby is in trouble, you need a cesarean,” when they want so badly for you to have a repeat cesarean? Is it possible for you to find another OB? At this point, it is so late in your pregnancy it might be hard to find another provider who is willing to take you on, but it might be worth a phone call or two. You can also join this VBAC support group. There are several traveling midwives on that list who might be able to help. But act quick! Please let me know what happens! Best, Jen
Wow, I am so glad I found this website.
I live in New Zealand, and am so glad that NZ is ‘into’ VBACs and VBA2Cs, and am planning my own for April 09.
My first child, was cs in Nov 07, due to severe IUGR, low blood flow (under 1/2) and very low heart rate. He was thought to be breech, and I had a 37 week malpresentation/growth scan which showed all this. (lol turned out he wasnt breech after all!)
Anyways. This website has given me so much info, and made me that much more sure about a VBAC!.
Thank you!!!
The information you have provided for women considering a vbac is excellent. Thank you!
I am 37 weeks with my second pregnancy. My first child was delivered via CS due to her frank breech position that was not detected until spontaneous labor at 41 weeks. I was devastated over the CS.
I originally planned a repeat CS on the advice of my OB. However, I went for a routine check up at 34 weeks and saw another OB very experienced in VBACs. We began talking about it, I went home and researched it and decided to go for the VBAC.
However, this week at my 36 week check up, my OB told me that he would artificially rupture the membranes if I did not go into labor spontaneously at 39 weeks. He explained that vbac candidates should not go past 40 weeks.
Does this carry the same risk as induction using drugs? Please provide me with any information…I am very uneasy over this.
Jennifer,
It so bothers me when OBs lie to patients. There is no rule that VBACs can’t go past 40 weeks. This is up to the OB’s discretion and I think, is one of the ways that OBs who aren’t truly supportive of VBAC undermine you while making you think they are “giving you a chance.”
From Wikipedia: “Maternal risk factors for a premature rupture of membranes include chorioamnionitis or sepsis. Fetal factors include prematurity, infection, cord prolapse, or malpresentation”
The article 5 Reasons to Avoid of Induction of Labor lists the following risks:
When you are induced, your body is being forced into labor, so contractions can either 1. not start or 2. start and then stop. Your OB then has three options: 1. augment your labor with drugs (which come with risks), 2. diagnose you as FTP (failure to progress) and perform a cesarean, or 3. wait. However, once your water has been broken, the clock starts meaning your OB may only “permit” you to labor for 12 – 24 hours before s/he requires a repeat cesarean because s/he is concerned about infection (aka chorioamnionitis or sepsis). You can reduce the risk of infection by declining vaginal exams, but once that water breaks, the baby will be born one way or another.
You might be interested to read this article that discusses how many drugs used to induce/augment labor are not approved by the FDA for that use.
To me, your OB doesn’t sound real supportive of VBAC and that is the fundamental problem. Is there anyway to switch to the pro-VBAC OB in your OBs practice? Since your OB initially advised you to have a repeat cesarean, my gut tells me, you will have a cesarean for some reason if you stick with him/her.
I wish you the best of luck and please keep me posted.
Jen
I’m looking for a OB who would be supportive of VBAC in Los Angeles area or Ventura county, can anyone help me.
Thank you for your help
Geraldine, Check out Dr. Stuart J. Fischbein, you can also read the post Finding a VBAC Supportive OB or Midwife which lists a variety of sources for OB/midwife referrals, and check out the List of Southern California Midwives. Best, Jen
[...] VBAC Facts [...]
At 35 weeks pregnant, I have just come from a meeting with my consultant. While he claimed the hospital (in the UK) was supportive of a VBAC, with every question he answered alarm bells were ringing. Thank you for such an informative and, crucially, well-referenced site. I feel encouraged to go back with a well researched birthplan and search out a consultant who is truly committed to enabling successful VBACs rather than simply preparing women for the ‘inevitable’ second CS.
I really would like to know of anyone knows a doctor that will help me have a VBAC in albuquerque new mexico. my feelings were hurt when my doctor said there is no one in the state of new mexico that will take me and that i will have to have another provider if a VBAC is what i want. my due date is 1/29/2008 and i am new to new mexico. i already had 2 c-sections and i don’t want another one. please help anyone.
Xochitl, I’m so sorry you are going through this. You do have options. If there are no OBs in your area, you can consider homebirth with either a local midwife or a traveling midwife. Please read Finding a VBAC Supportive OB or Midwife which will give you a list of groups, “in real life” as well as on-line, who can help. Please keep me posted okay? Take care, Jen
Hi,
Thank you for the great website!
I am planning to have a vbac at a hospital in Geneva, Switzerland. In general, they are very supportive of vbacs here.
It is common practice here to measure the uterine scar at 37 weeks using a sonogram. Apparently, if the scar tissue is 3.5mm or higher – it is very unlikely for a rupture. Mine happens to be 2.95mm. The hospital staff tells me I have a 3 – 4% chance of a rupture versus a standard .05% chance of rupture. They warned me that I will be monitored heavily during the birth because of these factors. Do you know much about this theory or know where I can find more information about this?
Thanks so much.
Virginia, First, I am not a medical professional, so i cannot give you medical advice, but I can give you my lay opinion. I’ve been researching this and hope to share the details in the coming weeks. There are several studies that examine uterine thickness and the risk of uterine rupture in women with prior cesareans, but all of these studies are to small, consisting of a couple hundred women or smaller, to influence obstetric policy. Is it possible to find another OB or even have a homebirth? Best, Jen
[...] I went in for my 6-week post-partum appointment with the OB who did my surgery and was told about uterine rupture.^ And then last July-August when I was preparing for baby #2 I learned so much about the failings [...]
i have one child born vaginally, and my second was born by c-section. my third is due to be born 16.5 months after my c-section. My doctor is not thrilled about doing a vbac because there are less than 18 mo.s between the two births. Any info. about this?
HI Rina
Although you would have by now birthed your baby, hopefully the way you wanted, you might be interested to know I had a VBAC with my second baby, and he was born only 11 1/2months after my ceasar. My Dr’s comment when I asked about VBAC early in pregnancy was that it is safe to give birth 3 months after a ceasarean!!
Thanks so much for all your hard work!
I also had a CS delivery with my daughter because she was a footling breech presentation, but that was in NYC in 1992:) Then I had a home birth VBAC in 1995, which was the best thing I have done in my life. The back up OB to my then midwife told me he delivered footlings regularly so long as there wasn’t an issue with cord prolapse. I think this practice among OB’s is becoming more and more obsolete, I’m afraid.
Now I find myself due in September with my third, at my advanced maternal age of 45, in a state that has outlawed home birth VBACs:( NJ.
Do you know of any AMA risk factors concerning VBACs? I’ve read of a little increase of uterine rupture chances, in a Swedish study… but don’t know of any others. Just met a midwife who has worked with her back up OB in his hospital setting, and he has been, according to her, really great in letting her do everything all the way up to the catching of the baby. She has promised to be a strong advocate if I choose to go that route. Haven’t met him(the OB) yet, but can’t wait to use your very helpful list of questions on him… there were a couple that I would have forgotten to ask.
I would LOVE to do another home birth, but I would hate to have keep it secret, and break a law, and worry about a midwife losing her license. I’m also a little further from any hospital this time, 30 minutes, and would hate to transfer all by myself because of this law. It’ s too bad really ’cause the midwife said that Oxford, which is my insurance, is the only company that fully covers her home birth fees!!
Hello-
I want to put in a word from the other side of a uterine rupture. I wonder if you will be brave enough to print it. I was much like you before my VBAC disaster. I read most of the literature you cite, devoured Ina May, dreamt of a beautiful vaginal birth. I was an ideal candidate. Well, I went into a very fast labor at home and had ruptured by the time I made it to the hospital. My son was born essentially dead, had seizures and brain injury. While I think every woman should have the choice, I urge moms to consider that the risk of catastrophe for your baby is higher for VBAC. (the study you reference with increased infant mortality in CS is for PRIMARY elective CS compared to vaginal). So, you too, may be one of the unlucky moms forced to live with this choice forever. I would have rather have had CS complications for myself.
I cannot begin to imagine the pain you have experienced and continue to experience. I am so sorry about your son.
Just as there is no way to predict who will experience a uterine rupture, there is no way to predict who will suffer the consequences of major abdominal surgery.
I wish there was a fool proof way to guarantee every woman a safe passage to motherhood and there were no babies to mourn.
How brave and honest of you to tell us your story. I have been feeling like all the notes are roses and tulips with no real “hard truth”. This is a difficult decision for anyone to make. Unfortunately, babies do die sometimes. My heart aches for your loss and I will pray for you. I am a Christian and believe that God has forgiven you for whatever mistakes you feel you have made and that he made your baby perfect regardless of the outcome. Hind sight is 20/20. I hope you can move forward after this as again, I can only imagine the pain your heart must be sufferring right now. You are in my prayers…
my provider is willin to let me go to 42 weeks but if im not in labor by then theyll c-section me is that a red flag?
[...] Руптура на матката – за повече статистика тук: http://vbacfacts.com/vbac/#URVC Изследване на населението на повече от 250,000 жени в [...]
Hi, I too live in NZ and, although it’s not legally necessary here, I’m in the process of attempting to persuade an obstetrician in my local hospital to give his medical backing to my planned vba2c in July. Do you know of any studies showing intermittent monitoring can be as good as continuous as I have no doubt being strapped to a bed throughout the labour is not going to aid a successful outcome. (PS I will be going ahead with the vba2c anyway just trying to work with the medical community here and they seem to be receptive to research so far).
[...] намалява рискът от руптура на матката при настоящата пременност, но не го [...]
Hello,
I am a homebirthing mother who had a 24 week preemie who was taken via Classic C-section. After that, I was told I could never have another Vaginal birth. (he was my 3rd) I was disappointed as his section was a horrible experience for me. Then a DO told me it was possible to have a V-bac even with a classic cut. That planted seed in my mind to reseach. I found ICAN, read up on it in the Library and researched for hours on the internet. I was willing to take the risk and pray as well because I choose to be drug free during labor.
I live in Indiana where it is illegal to have a VBAC after classic. My CNM could not do it lest she loose her license if something went wrong. We travelled a long way to have our baby and all went well. After reading of the lady above who did rupture…my heart goes out to her and as I read I wonder if those who have very short labors are more at risk? I have 2-3 day labors which while it is happening seems to never end, seems to be a good thing in that it is slow and not so hard on the uterus. My contractions never went to a minute up to the end.
Now, I was told recently by a different DO that the most danger is in the second V-BAC after classic. I had not heard that and wondered if someone would give me some facts on this.
I would have no problem going to a hospital, but they do NOT let you labor as long as necessary and love to “speed” up a natrual process.
I am not pregant right now, but do want to explore these things so I am prepared. C-section is the LAST on my list to do, but if it is more of a risk this time then last, I’m not sure what to do.
while this article automatically denines itself the same liberty the first paragraph/quote states, Nothing in heaven or earth could have changed my birth experience. i have had a vbac and this article though i didnt read pass the second paragraph in the main article is full of bullshit by its own wording. know your body and believe in it. i didnt have the support of anyone not doctors nurses husband or community. this is the generation of my body my choice for the baby then know your body and do whats right for you. i would say this i got to see my daughter right away after my vbac i didnt get to see my son for over 24 hours because he was under opservation of the hospital. i delievered at the top naval hospital in the nation so i know that he was well taken care of but csections are over used and really should be discuraged by our medical community. instead they are used to plan your life around the child. they are babies not a lunch meeting with your best friend.you are going through major surgery compared to the natural way of nature or the way the heavens wanted our bodies to function. we as woman have decided we are equal in so many ways but have denied ourselfs natural abilities to “keep up with a man” think things through. i might sound like some old hippie when in fact my mom was but i believe we as women need to not deny our female right to our bodies. im not a number a percent or a test study i am a woman and i want the best for my baby. if you read this anti-vbac website i challenge you to read a pro-website as well get all the facts.
Hi there. I am 27 years old and had our first child 5 years ago. They had to get our son via c-section because he was breech. I got pregnant again 6 months after our first child was born. We had twins and they were born via c-section as well. I am currently pregnant with our 4th child (four years later). I have no medical needs for a repeat c-section accept that I had two previous c-sections. The baby is head down and the pregnancy has been very good with no complications. They removed the first scare with the second c-dection so there is really only one scare there. I was told by my OBGYN that it is standard procedure to have a 3rd c-section at this point. I am absolutely not happy with that and I am currently trying to find a different doctor who has experience with VBACs. I find it extremely frustrating that they are trying to tell me how I have to deliver our son. It is my body and since I have no medical problems I should be able to at least ry to give birth vaginally. The problem is that I am running out of time. My due date is in 3 weeks!!!!
I love this web site. Thank you so much for all the information. It is very helpful. Doctors like to have stupid patients. It almost seems like they are mad when they see you educated yourself and don’t agree with them. A lot of times they just like the convenience of a planned c-section. My doctor wouldn’t even let me pick the surgery date. She said she would take the baby at a different date but she will be on leave. What kind of statement is this? It is a matter of money as well. They make so much more money performing a c-section and like this web site said they will not be called to deliver a child at some crazy early morning hour.
I am in a similar situation. Due with baby 4 early Nov based on my calculations. Dr. wants to use an US date and schedule a Csection at the end of the month. Way too early if you ask me. I want a trial of labor and am fighting a bit with her and the hospital about it, plus am trying to educate my husband so that he will be supportive. Please let me know how your delivery goes. I will be praying for you and your baby
Paige
I had my first child in April. At 39 weeks and 4 days my water broke in the middle of the night. I went in at 2 cm dialated and 50% effaced. My contractions weren’t very strong so they put me on pitocin. After 4 hours on pitocin my stand-in doctor (the one on call, not my OB) HIGHLY suggested an epidural. Ten hours into labor I got the epidural. Seventeen and a half hours into labor (at 7 cm dialted), my child was diagnosed with fetal distress and I had an emergency CS. I have a bikini incision. Turns out my daughter was face up (though my husband and I already knew that from an ultrsound teo days before, so I assumed my doctor knew about it too, however nothing was done to try and turn her) forehead first, and the cord wrapped around her (she was a VERY active baby in utero). I am currently not pregnant but am researching VBACs as much as I can. Do you think I would be a good candidate for a VBAC? Any input would be greatly appreciated! Thank you for taking the time to read this LONG message.
This is an obviously well researched website. Nice work. Professional.
I am 8 weeks prego with my 4th baby. 1 miscar at 11w. 1 boy 4y, 1 girl 14m. i had an emergency cs with my first. the dr informed us that his heart rate was dropping and he was in distress. after bein induced for two hours they said they could not wait any longer and they need to do a cs. I agreed. I was afraid for my baby. WHen he was delivered i remember them saying he was extreamly large (8 11 at 6 days early) and that he was sunny side up. when i became pregnant with our second I really wanted to vbac. Was told “I couldnt being that I have large babies. My husband is tall 6 4 and myself tall 5 7″ we both have small frames. My husband is as skinny as a bean pole. I found out later non of that actually matters anyway. A doctoe can not tell if a baby it too big unless there is TOL!!! I didn’t know this until after my 6 13 daughter was born. I argued with the dr about her size up until the day she was born. I knew she was not as heavy as my first. Long yes, but not as big. He declined my opinion and went through with his. I remeber having complications with them placing the spinal. They even stated that if it dosent work this time we will put you under. I said great! I have of fear of being cut open while awake and aware of whats going on. Its super freaky and unnatural to me! I would much rather be asleep and wake up to meet my lovely new baby. It would have also saved me from hearing about politics that they discussed during my section, being that my daughter was born on election day. it truely was terrible. I remember my heart rate dropping, being unable to breath, the extreme hot flashes, the red splotches that had the dr in a panic. It was horrible. I had many allergic reactions to the spinal they gave me (still cant figure out why they did not give and epi like the first time) i almost died. and the joyest part is when the presented this tiny peanut they said was my large baby. I was mad. your first reaction to your baby should never be anger. I was mad at the dr that knew better than I. so this time i am not falling for the dr knows best CRAP! I am having a vbac. most hospitals and drs bann it here. again crap. so now we have to drive 1 1/2 hours to try this vbac. being that we live far this dr wants to induce. I am saying no, my better judgement says no. but she says if your going to rupture your going to induction dosnt inprove the risk. More crap. Our other option is to drive 3 hours to the top hospital around here. this is just such a hard decision, and i’m left feeling powerless over my own body. since when did giving birth have to be so complicated? I want to vbac here close to home, close to my other children. What are my options? after reviewing my operative report, ehich is full of truth they did not give me. they told me lies and printed the truth. My son was posterior and they knew it during labor. this was never mentioned. his fetal distress is also never mentioned in this report. Conclusion : there was no fd they just wanted to have a baby NOW! it talks about my second section and my council to vbac. I was told NO from the begining. signing a stupid form dose not give you an option!
Cant say thanks enough for this research.
I had a myomectomy 2 years ago (bikini cut, within the muscle not in the Uterus itself)and am now 30 weeks pregnant. All the Doctors I have seen so far in Kenya immediately pull out the CS card when I tell them. My husband and I have been so worried as we have had a stress free pregnancy and would like to have a VB.
This article has helped us and I will be more armed at my next appointment.
Thanks so much.
Amina
[...] great information on the real risks of VBAC visit the VBACFACTS site. Possibly related posts: (automatically generated)PUPPS – horrible pregnancy rashNo TitleSail [...]
I am 39. My first baby was born in 88 by c-section. I have had 3 successful vaginal deliveries since. My OB moved away so I went to his partner. The hospital there does not allow VBAC’S and he tells me right off “you are a perfect candidate for a VBAC, but we will have to schedual a c-section” I have had 3 natural deliveries since my c-section, how can I just think that schedualing a c-section is the right thing to do? I have made an appt. with another OBGYN in another town. This just seems so unfare!
Marcee, you can say no to the hospital, they have no legal right to make you undergo surgery, have you considered getting a midwife and doing it at home. I assume since you have had many succesful vbacs you would be a wonderful candidate.
I am 34. I delivered my first baby in April 2009 in St Peters Nj through an emergency c. I was 37 weeks and low on water and so I was induced. The baby’s heart rate dropped drastically and so I was told that I had to be operated. Now I am planning on a second one but want a VBAC. Can you recommend some good VBAC doctors in NJ?
Hi Sara!
I don’t know of any doctors in New Jersey, but here are a list of resources for finding one: http://vbacfacts.com/2008/03/08/finding-a-vbac-supportive-ob-or-midwife/.
Warmly,
Jen