There is much controversy surrounding the safety of VBAC (vaginal birth after caesarean), so much so that some hospitals are now refusing to admit women requesting this type of birth. A lot of hospitals and birthing centers started dropping their VBAC practices soon after the American College of Obstetricians and Gynecologists (ACOG) released a 1999 bulletin urging doctors to only perform a VBAC in a setting where proper emergency care is available.
According to an article published in the American Academy of Family Physicians (http://www.aafp.org/afp/990915ap/special.html) the ACOG still promotes the inclusion of VBAC as a birthing option, but it also takes the stance that no current or past study has proven that maternal and neonatal outcomes are better with VBAC than with repeat cesarean.
The American Academy of Family Physicians also provides a list that the ACOG gives to identify candidates for a VBAC:
- One or two previous low-transverse cesarean deliveries. - Clinically adequate pelvis. - No other uterine scars or previous rupture. - Physician immediately available throughout active labor capable of monitoring labor and performing an emergency cesarean delivery. - Availability of anesthesia and personnel for emergency cesarean delivery.
One popular 2001 study published in the New England Journal of Medicine (http://content.nejm.org/cgi/content/short/345/1/3) concluded that women who chose to have a VBAC were at a higher risk of uterine rupture than those women who had planned cesarean deliveries. The study goes on to say that women who were induced using a prostaglandin (a cervical ripening agent) before their VBAC were at a much greater risk of rupture.
These findings, however, are very controversial because they only focus on uterine rupture. For example, the risks of having a second cesarean alone can range from severe infection to subsequent infertility. The findings give no information about other risks of cesareans versus VBAC.
The wide range of conflicting research, studies, and recommendations only add to the confusion of making such an important decision.
After doing the research then sitting down with physician and family, how does a woman decide?
Do you think doctors and hospitals should be required to perform VBAC if a woman has chosen it as her birthing option and is a viable candidate for the procedure?
(If you are thinking about having a VBAC, you can find an extensive list of support groups at http://www.vbac.com/supportgroups.html.)
As woman who has had four successful VBAC's after a ceseaean, I would have to encourage other women in this situation to try to find a dr who would at least be willing to allow them to attempt a VBAC.
I was very aware with each of my VBAC's that at any point if my Dr. felt a c-section was necessary that I would be taken to surgery.
Commnuncation between mother and Dr. is key!
cvarano::
on Jun 19, 2007
It is definitely a decision everyone would have to make on their own. If it were me I would want to take no chances. I would just have another caesarean. It wouldn't be worth the possible risk to have a natural birth and either way I would have a beautiful healthy baby at the end of it all and that's the important part.
twinmamma::
on Jun 20, 2007
I think that with any medical care Dr./Patient communication is VITAL. Dr.s need to lay all of their concerns on the table and have the right 'plan B' in place with the patience understanding that if an emergancy were to come into play the Dr. can go to 'plan B'. However, the ultimate decision is the patients. I had a very successful vaginal birth with twins and understand the joy of giving birth, but also knew that at any moment my doctor could choose a c-section for the babies safety. An OB's job isn't just to protect the mother, it is to protect the child..
tcarr01::
on Jun 20, 2007
I attempted a VBAC after my first baby because I wanted to experience a natural birth and the caesaren was done because I had been in labor for 24hrs and never progressed past 6cm. It was important for me to at least try(didn't work) and my doctor understood that and actually encouraged it. I'm with the other women who believe that open communication with your Dr. is important. When I found out I was pregnant, the 2nd time, VBAC was one of the first things we discussed. Every situation is different and there may be medical reasons that your doctor feels strongly about, which supports his decision not to approve a VBAC. Everyone should approach the situation with an open mind to ensure that the BEST decision is made.
kabcat::
on Jun 20, 2007
I think that it should be up to the mother. I had my first child by cesarean due to not being able to dilate all the way but with my second child i tried VBAC but ended up not being able to dilate again i was in labor for a long time and ended up doing a caesarean, But i think that trying to do the VBAC after my first child was born was worth it even though i had to have the caesarean. As long as the baby isn't compromised it should be the mothers choice.
Rosycheeks::
on Jun 21, 2007
I had to have a cesarean too with my first born this past April. I was set to give birth vaginally, but after 20 hours of labor, the baby wasn't budging, his heartrate kept going up and down, the dr talked c-section and that's what we did. I was glad too for my baby's safety. I don't think I will take the risk of a VBAC and have a c-section again the next time around. I agree, it should be a decision left for the mother. We know our bodies and what they can handle. It's kind of weird, but I had a feeling that I would end up having a cesarean birth and I did.
MamiMari::
on Jun 22, 2007
Ladies we must all remember that no matter how your child arrives into this world, VBAC or C-section, the outcome is the same...we become mothers to a precious gift. I had an emergency C-section with my first child due to complications at 25 weeks. When i became pregnant w/ my 2nd i wanted a VBAC be/c i thought i had missed out on a rite of passage. LABOR. Every week for 32 weeks after i found out i was pregnant i had to be seen by the Dr and every week we discussed it-VBAC. In the end we scehduled an appt at 38 weeks to deliver my son. I never experienced my water breaking, labor pains, or yelling at my husband for doing this to me. Instead the day before my mom and I had a mother -daughter day at the Spa. I got my hair and nails done and a massage. The next day we took our kids (i have 2 stepsons and a girl) to stay with friends while my mom and hubby took me to the hospital. we unpacked and got settled. we were wheeled in, a local anesthetic was given and out he came. Half an hour later he was in my arms in my room. After it was all said in done, it didn't matter. My children were born and the only thing on my mind after that was enjoying them. But that is my story. Discussing with your doctor your capabilities and the risks to you and your child are key. Every woman is different and what may work for one may not necessarily work for another.
busytwinsmom::
on Jun 23, 2007
The reason the docs are so uptight about vbac is a missed diagnose or report by nurse of uterine rupture in its early stage..which doesn't last long, before it is deadly.
I have had 2 c-sections, which were medically necesary: first one due to my cervix closing after dialation...second one due to a twin delivery with large twins.
I think that before taking the risk, we should just ask why we want to go that way?
Is it for the experience? Is it to compensate for that slight twinge of guilt that we feel for not delivering aux natural? Because both of these reasons are less important that the safest possible delivery of our babies, and the saving of our lives.
There are lots of pains during labor. I pain in the side during a contraction that could be guesses as adhesions, just might be your babie's head popping out the side of your uterus, on the inside of your belly. I personally, don't feel comfortable taking this chance and I understand how a doctor wouldn't either.
gypsy4360::
on Jun 24, 2007
I had my first son via c-section, after 30 hours of labor. I really hated that. I pushed and tried, unmedicated, until they told me it was no longer safe for my son. Then I agreed to the procedure. I believe I actually mourned the fact that I could not birth my own child. 14 months later I was happily pregnant again. I searched low and high to find a dr. who would allow me to do v-bac. I was elated. Then at 23 wks, I found out I was having twins. My dr. backed out of the v-bac. No one else would take me. Short of having an unattended home birth, I had no other choice but to have another c-section. I knew that this would be my last pregnancy and my last chance for what I felt was a real birth. I will never be at peace with the fact that I had no choice of my own. I was forced into something that I didn't want or need. I feel like it is sheer laziness on the dr.'s part. He would have to be in the room doing his job for more than the average birth, and this is just asking to much.
I hope in the future that this changes. It is a very unfair practice to deny a natural birth to any mother who feels like it is what she needs to do.
Lovemiracle::
on Jun 25, 2007
I had my only daughter via Emergency C-Section, and I'm planing on having one more child in the next couple of years, my choice this time it's a C-Section, I don't want to take chances or risk my health/life and my baby's life.
