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Thoughts on VBAC after three or more prior cesareans

Thoughts on VBAC after three or more prior cesareans

ACOG’s 2010 VBAC recommendations affirm that VBA2C (vaginal birth after two cesareans) is reasonable in “some” women. But they remain silent on VBAMC (VBAC after multiple cesareans.) Some have interpreted that silence to mean that ACOG does not recommend VBAMC, yet ACOG is clear that women shouldn’t be forced to have cesareans.

Just kicking the can of risk down the road

Just kicking the can of risk down the road

If primary and secondary cesarean rates continue to rise as they have in recent years, by 2020 the cesarean delivery rate will be 56.2%, and there will be an additional 6236 placenta previas, 4504 placenta accretas, and 130 maternal deaths annually. The rise in these complications will lag behind the rise in cesareans by approximately 6 years.

Risk of serious complications increase with each cesarean surgery

Risk of serious complications increase with each cesarean surgery

Per Silver (2006), “The risks of placenta accreta, cystotomy [surgical incision of the urinary bladder], bowel injury, ureteral [ureters are muscular ducts that propel urine from the kidneys to the urinary bladder] injury, and ileus [disruption of the normal propulsive gastrointestinal motor activity], the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries.”

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.

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