Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery.
Studies show that VBACs are more risky for the woman and baby than a repeat c-section. The most serious danger of VBACs is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. While very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. Even so, uterine rupture can lead to life-threatening bleeding for the mother and brain damage or even death for the baby.
The biggest and best study on VBACs was published in the New England Journal of Medicine in 2004. The researchers studied more than 30,000 women who had had a c-section and were pregnant again. Some of these women chose to have a VBAC. Others decided on a repeat c-section. The doctors compared the health of the women and babies after both types of delivery.
Almost three-quarters (73%) of women had a successful VBAC. The other 27% of women who tried to deliver vaginally ended up having another c-section. While rare, problems with the woman and baby were more common among VBACs compared with repeat c-sections. Only 0.8 % of women had a uterine rupture. Women who tried VBACs had more blood transfusions and a greater risk of endometriosis than those who had repeat c-sections. Babies born by VBAC had a higher risk of brain damage than those born by repeat c-section.
The percent of VBACs is dropping in the United States for many reasons. Women, doctors and hospitals are worried about the rare, yet possible problems of VBACs. A growing number of doctors and hospitals are banning VBACs. They are afraid of lawsuits that might follow VBACs that go wrong. In 2004 the American College of Obstetricians and Gynecologists recommended that hospitals have a surgical team "immediately available" whenever a woman is having a VBAC. In other words, ACOG suggests that a surgeon, nurses and an anesthesiologist be standing by in case an emergency c-section is needed. Guaranteeing this stand-by team is just too expensive for many hospitals.
Doctors are also discouraging or flat out refusing to perform VBACs. Sometimes this is because their affiliated hospital does not allow them. In other cases, doctors can not get malpractice insurance to cover claims related to VBACs. And some doctors admit they are afraid of getting sued if a VBAC goes wrong.
Choosing to try a VBAC is a difficult decision for many women. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your decision.
The American College of Obstetricians and Gynecologists (ACOG) recommends that doctors consider VBACS when:
- a woman has had 1 previous planned c-sections done with a low, horizontal cut or incision ("bikini" incision)
- a woman has no other uterine scars (aside from the prior c-section) or problems
- a woman has no known problems with her pelvis
- a doctor is present during all of labor and delivery and can perform an emergency c-section if needed
- an anesthesiologist and other members of a surgical team are standing by in case an emergency c-section is needed
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