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Over the course of the past 15 years, I have come across a lot of misinformation about VBAC.

All of the myths below have come straight from readers who have asked me, “Is this true?”

And every single time, the answer has been, “No.”

I thought it was time to pluck out the most pervasive VBAC myths and assemble them into one article… and downloadable handout.

These myths cover basic things like uterine rupture rates to difficult topics like death and logistical things like hospital policy.

In the end, all of these myths confuse birthing women and people about their options making it impossible for them to make a truly informed decision between vaginal birth after cesarean (VBAC) and elective repeat cesarean section.

What myths have you heard about VBAC? Let me know in the comments below.


Many people believe, “once a cesarean, always a cesarean.” This prevailing conventional wisdom is greatly influenced by persistent and pervasive myths about VBAC. It’s time for some clarity.

Myth: Once a cesarean, always a cesarean.

According to the National Institutes of Health (NIH), “VBAC is a reasonable and safe choice for the majority of people with a prior cesarean.” [1]

The American College of Obstetricians (ACOG) concurred when they said: “The preponderance of evidence suggests that most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about and offered TOLAC [trial of labor after cesarean].” [2]

Myth: Planned labor after one cesarean has a 60% uterine rupture risk.

The risk of uterine rupture during a labor after one low transverse (bikini) cut cesarean is about 0.5%–1% depending on factors. [1]

First time parents are also at risk for serious complications that can require delivery via emergency cesarean. [3,4,5]

Myth: Hospitals ban VBAC because it’s such a serious and unusual complication that they cannot manage it.

Hospitals with labor and delivery units have protocols in place to respond to obstetrical emergencies.

The guidelines used to manage the complications among first time and repeat cesarean mothers are also used to address uterine rupture in those planning VBACs.

Myth: To expedite an emergency cesarean, epidurals are required in planned VBAC. [OR] Those planning VBACs can’t have epidurals because they obscure the pain of uterine rupture.

Per ACOG, epidurals may be used during a planned VBAC [2] and evidence suggests that epidurals do not mask uterine rupture-related pain. [6]

However, only 26% of women who experience a uterine rupture report abdominal pain, so it is an inconsistent and unreliable symptom. [7]

Myth: There is a 25% chance that someone will die during a VBAC.

The risk of maternal mortality is very low whether a birthing person plans a VBAC (0.0038%) or an elective repeat cesarean (0.0134%). [1] While the risk of an infant death during labor or within 28 days of being born (perinatal mortality) is higher with a planned VBAC (0.13%) than a repeat cesarean (0.05%), the risk is still low. [2]

So what about the risk of infant death and uterine rupture? Limited research suggests that 2.8 – 6.2% of uterine ruptures during planned VBACs result in perinatal mortality. [1] This translates into an overall risk of 0.0196% – 0.04340%. This risk is even lower when labors begin and progress naturally.

Myth: There are no risks associated with cesareans other than surgery.

The most serious cesarean-related complications become more likely as an individual woman has more cesareans. [8]

Placenta accreta, when the placenta embeds too deep within the uterus, is one such condition. It carries its own risks including excessive bleeding, blood transfusion, hysterectomy, surgical injury, and maternal death. [9]

After two cesareans, the risk of accreta is 0.57%, [8] slightly higher than the risk of uterine rupture after one cesarean.

Myth: I can’t have a VBAC in my state because it’s illegal.

VBAC is legal throughout the United States and in some states, it’s legal for a midwife to attend a community VBAC where birth occurs at home or at a birth center.

Myth: My doctor will lose their medical license if I have a uterine rupture.

Farah Diaz-Tello, Senior Counsel & Legal Director at If/When/How: Lawyering for Reproductive Justice clarifies, “I have never heard of a situation in which a physician has lost their license for adhering to a woman’s wishes after providing them with full informed consent, and attending them in a manner that is consistent with the standard of care. Even physicians who have been found liable for medical malpractice do not automatically lose their license.”

Myth: Planned VBACs shouldn’t be induced.

When a complication requires the baby to be born sooner rather than later, but not necessarily in the next ten minutes, induction can make the difference between a VBAC and a repeat cesarean.

This is why ACOG maintains that medically indicated induction “remains an option” during a VBAC. [2]

Myth: Hospitals ban VBAC because they can’t meet ACOG’s “immediately available” requirement.

Some hospitals interpret AC0G’s “immediately available” recommendation to be a mandate that an anesthesiologist must be in the hospital 24/7. Some hospitals that cannot provide that level of coverage have banned VBAC.

However, “immediately available” does not have a standard definition and hospitals across the country implement the guideline in different ways. [12]

Myth: Hospitals that do not have 24/7 anesthesia coverage ban VBAC.

There are hospitals that offer VBAC without 24/7 anesthesia. The rural hospitals that serve the Navajo Nation in New Mexico are an example with a 38% VBAC rate. [10] Contrast that to the VBAC rate in the US: 14%. [11]

Myth: The evidence shows that 24/7 anesthesia coverage creates a safer environment for VBAC.

AC0G confirms that the data is not available: “Although there is reason to think that more rapid availability of cesarean delivery may provide a small incremental benefit in safety, comparative data examining in detail the effect of alternate systems and response times are not available.” [2]

In the absence of empirical evidence, the “immediately available” recommendation is based on the lowest level of evidence which is “consensus opinion.” [2]

Hospitals without 24/7 anesthesia implement a variety of policies to make VBAC safer including fire drills and cesarean under local anesthesia. [10]

Myth: If your hospital doesn’t offer VBAC, you have to have a repeat cesarean.

As Howard Minkoff MD said at the 2010 NIH VBAC Conference, “Autonomy is an unrestricted negative right which means a woman, a person, anybody, has a right to refuse any surgery at any time.”[12]

ACOG affirms that, “Respect for patient autonomy also dictates that even if a center does not offer TOLAC, such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery.” [2]

There are real risks and benefits to VBAC and elective repeat cesarean section. Make the right decision for yourself: understand your options, discern truth from fiction, know your legal rights, and study the facts.

Want to learn more? Download our checklist outlining the 5 secrets to planning a VBAC, our report on the top 5 uterine rupture myths, or our handout which uses national VBAC guidelines to debunk even more VBAC myths.

If you are a parent who wants to avoid an unnecessary repeat cesarean, join me in “The Truth About VBAC™ for Families.” It’s the most comprehensive course available to parents on VBAC.

If you are a professional who wants to give families accurate information so they can make informed choices, our VBAC Facts® professional membership was made with you in mind.

Jen
  Resources Cited
  1. Guise, J.M., et al. (2010). Vaginal Birth After Cesarean: New Insights. Rockville (MD): Agency for Healthcare Research and Quality (US).
  2. American College of Obstetricians and Gynecologists. (2019). ACOG Practice Bulletin No. 205. Vaginal birth after cesarean delivery. Obstetrics & Gynecology, 133(2), e110-e127.
  3. Deering, S. H. (2018). Abruptio Placentae. Medscape: http://emedicine.medscape.com/article/252810-overview#a0199
  4. Beall, M. H. (2018). Umbilical Cord Complications.  Medscape: http://emedicine.medscape.com/article/262470-overview#a30
  5. Allen, R. H. (2022). Shoulder Dystocia. Medscape: http://emedicine.medscape.com/article/1602970-overview#a03
  6. Johnson, C., & Oriolf N. (1990, Nov-Dec). The role of epidural anesthesia in trial of labor. Regional Anesthesia & Pain Medicine, 15(6), pp. 304-8.
  7. Nahum, G. G. (2018). Uterine Rupture in Pregnancy. Medscape: http://emedicine.medscape.com/article/275854-overview#aw2aab6b6
  8. Silver, R. M., Landon, M. B., Rouse, D. J., & Levene, K. J. (2006). Maternal Morbidity associated with multiple repeat cesarean deliveries. Obstetrics & Genecology, 107, 1226-32.
  9. American College of Obstetricians and Gynecologists. (2018). Placenta accreta spectrum number 7 (replaces committee opinion no. 529, July 2012). Obstetrics & Gynecology, e259-e275.
  10. Bimbach, D. J. (2010, Mar). Impact of anesthesiologists on the incidence of vaginal birth after cesarean in the United States: Role of anesthesia availability, productivity, guidelines, and patient safety. Vaginal birth after cesarean: New Insights. Bethesda: National Institutes of Health.
  11. Osterman, M., Hamilton, B., Martin, J., Driscoll, A., & Valenzuela, C. (2022). Births: Final data for 2020. National Vital Statistics Reports; vol 70 no 17. Hyattsville, MD: National Center for Health Statistics.
  12. National Institutes of Health Development Conference Panel. (2010). National Institutes of Health Consensus Development conference statement: Vaginal birth after cesarean: New Insights. March 8-10, 2010. Obstetrics & Gynecology, 115(6), 1279-1295.

What do you think?
Leave a comment.

What do you think? Leave a comment.

2 Comments

  1. I’ve heard a lot about how you can’t have a VBAC if it is less than 18 months between pregnancies. My pregnancies were 9 months apart. Would a VBAC be an option?

    Reply
    • Hi Kyleigh, I write about birth intervals and VBAC here. The short answer is, yes, VBAC is an option with short birth intervals.

      Reply

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Jen Kamel

Jen Kamel is the CEO and Founder of VBAC Facts®. Since 2007, their focus has been to provide objective, accurate information about the data available on vaginal birth after cesarean and repeat cesarean to parents, professionals, policymakers, and the court so all decisions can be informed, ethical, and just. In this capacity, she creates educational courses for parents and CE trainings for professionals as a Continuing Education Provider through the California Board of Registered Nursing. She speaks at conferences around the world on the VBAC evidence as well as presents Grand Rounds at individual hospitals. In her ongoing efforts to educate policymakers on the VBAC evidence, she has testified multiple times in front of the California Medical Board and a variety of other regulatory committees as well as have consulted on legislation and regulation in multiple states. She serves as an expert witness and consultant in legal proceedings so the court may make its deliberations on the medical research rather than conventional wisdom.

Jen Kamel

Jen Kamel is the CEO and Founder of VBAC Facts®. Since 2007, their focus has been to provide objective, accurate information about the data available on vaginal birth after cesarean and repeat cesarean to parents, professionals, policymakers, and the court so all decisions can be informed, ethical, and just. In this capacity, she creates educational courses for parents and CE trainings for professionals as a Continuing Education Provider through the California Board of Registered Nursing. She speaks at conferences around the world on the VBAC evidence as well as presents Grand Rounds at individual hospitals. In her ongoing efforts to educate policymakers on the VBAC evidence, she has testified multiple times in front of the California Medical Board and a variety of other regulatory committees as well as have consulted on legislation and regulation in multiple states. She serves as an expert witness and consultant in legal proceedings so the court may make its deliberations on the medical research rather than conventional wisdom.

Free Handout Debunks...

There is a bit of myth and mystery surrounding what the American College of OB/GYNs (ACOG) says about VBAC, so let’s get to the facts, straight from the mouth of ACOG via their latest VBAC guidelines.

VBAC Facts® does not provide any medical advice and the information provided should not be so construed or used. Nothing provided by VBAC Facts® is intended to replace the services of a qualified physician or midwife or to be a substitute for medical advice of a qualified physician or midwife. You should not rely on anything provided by VBAC Facts® and you should consult a qualified health care professional in all matters relating to your health. Amazon Associates Disclosure: Jen Kamel is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. Created By: Jen Kamel | The Truth About VBAC™ and VBAC Facts® are trademarks of VBAC Facts® LLC and may not be used without prior written permission. All Rights Reserved. Copyright 2007-2021 VBAC Facts®. All Rights Reserved. | Terms of Use | Privacy Policy