VBAC Information
If you have had a cesarean birth and are pregnant again, you may be considering a VBAC: vaginal birth after cesarean. Some women choose to VBAC in the hospital with an OB, others choose HBAC (home birth after cesarean), and VBAmC (vaginal birth after multiple cesareans) is an option for still other women, and some women will have another cesarean, whether planned or unplanned. Whatever your personal decisions, ICAN is here to help you find complete and accurate information about VBAC and repeat cesarean, so you can make the best decision for yourself and for your baby.
In March of 2010, the National Institutes of Health convened a panel to assess available data relating to VBAC. The panel concluded that, “Given the available evidence, trial of labor is a reasonable option for many pregnant women with one prior low transverse uterine incision. The data reviewed in this report show that both trial of labor and elective repeat cesarean delivery for a pregnant woman with one prior transverse uterine incision have important risks and benefits and that these risks and benefits differ for the woman and her fetus.” They went on to say, “One of our major goals is to support pregnant women with one prior transverse uterine incision to make informed decisions about trial of labor compared with elective repeat cesarean delivery.” To read the entire panel statement, please visit: Vaginal Birth After Cesarean: New Insights Final Panel Statement.
http://consensus.nih.gov/2010/vbacstatement.htm
It can be difficult to sift through the NIH data and determine how it applies to our own pregnancies and births. A group of maternity care professionals and VBAC advocates came together to create an online resource guide titled “A Woman’s Guide to VBAC” http://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/ which addresses many common questions women may have about their birth choices following a cesarean delivery.
Quick facts about VBAC:
- On average, 74% of VBACs are successful.
- Uterine rupture occurs in about 0.5% of spontaneous VBAC labors.
- Use of chemical induction or augmentation agents is known to increase the risk of uterine rupture. Pitocin augmentation increases rupture risk to 0.7%, pitocin induction raises risk to 1.1%, and prostaglandins carry a risk from 2% to 8% depending on the agent used.
- The NIH found no maternal deaths related to uterine rupture.
- Neonatal outcomes following rupture can depend on the speed with which an emergency cesarean is performed. Best results have been found when the baby is delivered within 17 minutes of identifying the rupture.
- Maternal mortality is 3-4 times lower for mothers who choose VBAC.
- Any hospital that provides standard obstetric care can provide care for women who wish to VBAC. In July 2010, ACOG revised their VBAC guidelines to support informed decision-making for women who choose VBAC in hospitals that may not meet the previous “immediately available” anesthesia and surgeon standard.
- ACOG also revised their guideline for VBA2C (vaginal birth after two cesareans), acknowledging that, “it is reasonable to consider women with two previous low transverse cesarean deliveries to be candidates for TOLAC” (trial of labor after cesarean).
- Women with previous successful VBACs experience lower rates of uterine rupture, lower rates of complications, and higher rates of VBAC success in subsequent VBACs.
United States |
Colorado |
|
Cesarean Section |
31.8% |
25.8% |
VBAC |
8.3% |
16.2% |
(US rates unless otherwise noted) |
|
Without labor (scheduled repeat cesarean): |
0.2% |
Average rupture risk in all VBAC labors: |
0.7% |
Spontaneous VBAC labor: |
0.4% |
Spontaneous VBAC labor, augmented with pitocin: |
0.7% |
Pitocin induced VBAC labor: |
1.1% |
VBAC Labor induced with prostaglandins: |
2%-8% (higher rates with use of cytotec) |
Risk of rupture in an unscarred uterus |
0.012% (in developed countries; 0.07% worldwide) |
VBAC |
RCS |
|
Maternal mortality |
4 |
13 |
Hysterectomy |
157 |
280 |
Deep venous thrombosis |
40 |
100 |
Placental abnormalities |
|
significantly increase with multiple cesareans |
Fetal mortality |
130 |
50* |
Brachial plexus injury |
180 |
30** |
*The mortality rate for VBAC is similar to the mortality rate for first-time mothers who deliver vaginally. Additionally, the numbers here are at delivery and represent only a small fraction of deaths from all causes. The overall mortality rate is 1,073/100,000.
**In spite of the difference in rate of injury, no difference in long-term neurological impairment was noted
