(Health Secrets) Most women who give birth by Cesarean section in the U.S. assume that any future babies will also be delivered in the same way. However, a panel of expert doctors convened by the National Institutes of Health has suggested that Vaginal Birth after C Section is safe in the vast majority of cases and may be the healthier choice.
The c-section rate in America has been increasing for several years, and it is now thought that around 32% of babies are delivered in this way. The idea of vaginal birth after C section goes against the general thinking in this country, which is that an elective c-section is the only real option the second time around. But do women really have a choice?
Why is Vaginal Birth after C Section discouraged by doctors and hospitals?
For women who labor naturally after a c-section, there is a slight risk that the scar from their initial operation will rupture or tear. Doctors and hospitals are aware of this risk and are concerned about being sued if they recommend or offer the possibility of a vaginal birth after C section, which is also known as VBAC.
Thirty percent of U.S. hospitals have now stopped offering VBAC, partly due to the insurance risk, but also because guidelines from the American College of Obstetrics and Gynecologists suggest that a surgeon and anesthesiologist should be immediately available during a VBAC in case an emergency c-section is required. Many hospitals just don’t have the resources to provide this.
Currently only 80% of planned VBAC deliveries result in a successful natural birth, but experts believe that this figure could be increased if women were given more support in their decision to have a VBAC, and if hospitals were less eager to progress to a c-section.
What are the real risks of a scar rupture?
The statistics for scar rupture make scary reading. The figure quoted for scar rupture during VBAC in the U.S. is usually 0.5-1%, which is quite high at a minimum of one in two hundred cases. But what are the possible results of a scar rupture? The three horrifying scenarios publicized by the media are the death of the mother, the death of the baby, or an emergency hysterectomy for the mother, but how likely are these to occur?
- Death of the mother due to scar rupture after VBAC is virtually non existent, especially if the mother has a planned VBAC with an experienced professional in a medical facility.
- Fetal death from a scar rupture is extremely rare, with 0.01% of VBAC deliveries resulting in the death of the baby for any possible reason, not just because of a scar rupture.
- Hysterectomy following VBAC occurs in around 0.06% of cases. Mothers are much more likely to have to have a hysterectomy following an obstetric hemorrhage caused by a second c-section.
In reality, mother and baby usually do well after a scar rupture as long as they are able to receive medical attention fairly quickly. An experienced VBAC practitioner should be able to spot the signs of a rupture in time for an emergency c-section to take place, and a rupture can be detected in its early stages if fetal monitoring is used.
Empowering second time moms with the choice
Of course, if your baby dies as the result of a scar rupture after VBAC it will be devastating. It won’t matter to you whether the risk was 1% or 0.01%, but the current thinking is that mothers should have the freedom to make that choice.
The panel’s chairman, Dr. F. Gary Cunningham, says that their aim is to make people aware of the possibility of having a VBAC, and to change the guidelines so that more hospitals feel able to provide that option. “What we do hope is that women who are interested in having a trial of labor will have better access to safe trial of labor in a hospital. We hope that putting the data out there will prompt people to look at this problem.”
VBAC deliveries are preferable to second c-sections for a number of reasons:
- Quicker and easier recovery for the mother and a shorter stay in hospital
- Reduced blood loss and decreased chance of infection or complications
- Minimal disruption for the first child at a challenging time in life
- Benefits for mental health of mother and bonding with baby
CBS News Medical Correspondent Dr. Jennifer Ashton, a practicing OB-GYN, emphasizes that VBAC should be looked at on a case by case basis. Women should talk to their doctors to find out why they needed a c-section the first time around as this is a large predictive factor in whether a VBAC will be a safe option for them.
Although the change won’t happen overnight, it is hoped that opening up the possibility of vaginal birth after C section to second time moms may help to reduce the rate of elective C-sections, which involve major abdominal surgery potentially leading to all manner of complications.