In My Mother's House

VBAC: a safe alternative to repeat cesarean

by Nicette Jukelevics, MA, ICCE

As recently as 1995, one out of four women with a prior cesarean had a vaginal birth after cesarean (VBAC). But today, the VBAC rate has plummeted to less than one in ten. This is mainly as a result of several factors, including highly-publicized (and largely unfounded) fears about the supposed “dangers” of VBAC, resistance by malpractice insurers to cover VBAC and the high profitability of repeat cesareans. As the cesarean rate continues to climb year after year, it becomes increasingly important for women to have access to VBAC, and to more information about the benefits and risks of VBAC and repeat cesarean.

Low risk of uterine rupture

The single most controversial issue regarding VBAC is the possibility of a uterine rupture, the separation of the uterine scar from a prior cesarean during labor or birth. The risk is less than 1% for women with one prior low-segment horizontal uterine scar, and 60 to 75% of mothers who choose VBAC successfully avoid a repeat cesarean. In addition, the likelihood of having a safe VBAC actually increases with each subsequent labor and birth.

Repeat cesarean is not necessarily safer

While some argue that VBAC is unsafe, the truth is there is no evidence that routine repeat cesarean is any safer than a planned VBAC. To the contrary, there is plenty of evidence about the risks of repeat cesarean delivery, including:

• Higher risk of infection, adhesions, intestinal obstruction, chronic pain, ectopic pregnancy and placental problems compared to mothers who have a successful VBAC.
• Increased risk for hemorrhage severe enough to require a blood transfusion due to placental problems from accumulating cesareans.
• Higher likelihood of being re-hospitalized for complications related to the surgery.
• Decreased fertility and increased risk of miscarriage in future pregnancies.
  • Greater likelihood of difficulty with mother-infant attachment as well as establishing and continuing breastfeeding.
  • Elevated risk for prematurity and serious neonatal respiratory problems in baby.

What if the uterine scar gives way?

Even though the risk is very low, uterine rupture is a serious complication associated with VBAC and requires immediate medical attention. If the uterine scar gives way, a rapid cesarean is necessary. With a rapid cesarean, mothers and babies usually have favorable outcomes, although sometimes serious complications can arise.

For most women, having a VBAC is safer than having a repeat cesarean and it increases the safety of any future pregnancies and births for you and your baby. For a more complete comparison of the relative risks and benefits of VBAC and cesarean, visit www.childbirthconnection.org.

Ultimately, the choice is up to you, your partner and your care provider whether VBAC is right for your upcoming birth. Arm yourself with as much information as possible about the benefits and risks of VBAC to help you make an informed choice.