Making an informed choice about
Vaginal Birth After Caesarean (VBAC)
'I didn't want another Caesarean cause I knew
how long it took to recover and I had seen so many women give birth
naturally and they were able to get up and do what they wanted almost
straight after.'
A vaginal birth after a caesarean (VBAC), especially
after a LUSC, in the absence of medical complications associated
with this pregnancy, is the safer choice for most women.
A meta-analysis of literature concluded that 7 out
of 10 women, who undergo a trial of labour after a previous caesarean
section, can expect to birth vaginally11.
Uterine Rupture risks.
The scar from your previous caesarean is strong.
While many people fear that the scar will rupture, and cause the
death of the Mother and/ or her Child, medical studies have shown
that this risk is greatly overstated.
The only way that VBAC differs from other labours
is the small increased risk of uterine rupture - about 0.4% (one
in 250). The risk of uterine rupture prior to elective repeat caesarean
is 0.2% 12
To put this risk into some perspective, consider that
the probability of requiring a caesarean section for other emergency
obstetric situations (not related to the previous c/section), such
as acute foetal distress, cord prolapse or ante partum haemorrhage
is up to 30 times higher.13
Early VBAC studies did not always distinguish between
a scar rupture and dehiscence. The latter is a partial separation
of the uterine wall with little or no symptoms and minimal (if any)
maternal or foetal morbidity. The risk of uterine dehiscence or
rupture combined occurs with the same frequency, up to 2%, whether
a woman choses VBAC or planned repeat caesarean11.
A recent Australian study estimated the risk of uterine
rupture in VBAC at 0.3% (one in 300). In that study, the risk of
the baby dying because of uterine rupture in a woman trying for
VBAC was 0.05% (one in 2000)14.
It has been suggested that between 693 and 3332 women would need
to undergo elective repeat caesarean to prevent a single baby death
attributable to VBAC. 12
A VBAC, where not medically contraindicated (advised
against) has advantages for the baby, too. The contractions of labour
massage and stimulate the baby and get him/her ready for birth.
Waiting until labour starts assures that the baby is ready to enter
the world, rather than being immature, with lungs that may not be
able to cope with life outside his/her Mother's protective womb.
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