I had my third daughter about a year ago, it turned out to be an unplanned c-section due to failure to progress. My first two daughters were born naturally. We would like to have one more, but I'm concerned about having another c-section. I am a Jehovahs Witness and do not accept blood transfusions. So my question is, would it be to risky under these circumstances to try a VBAC, or would the c-section put me more at risk?
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Dr David
Moderator posted 20 December 2000 08:27 PM
Dawn
"Failure to progress" seems an unusual situation after two vaginal births. Was there a contributing factor such as malposition of the head (OP or "face-to-pubes)? This may be important as there may be ways you can help minimise the chance of this next time (see previous discussion of Optimal Fetal Positioning). See also a brief explanation of malposition http://www.bmj.org/cgi/content/full/318/7192/1192
It would be generally agreed that average blood loss is greater with caesarean than vaginal birth.
You are in that group of women (previous vaginal births) with the highest chance of VBAC (see Phelan) and the lowest chance of uterine rupture (see Zelop).
Dr.David
Refs:
Phelan JP et al. Vaginal birth after casarean. AmJOG 1987;157:1510-5.
Zelop CM et al. Effect of previous vaginal delivery on the risk of uterine rupture during a subsequent trial of labour. AmJOG Nov2000;183(5):1184-86.
DISCLAIMER:
This advice is of a general nature to help in decision-making. It
does not constitute recommended treatment for an individual. You must
consult your health care provider for individual
advice.
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Dr David's 2nd Response -
Moderator posted 21 December 2000 03:49 PM
Dawn
In a recent report, Mozurkewich et al looked at 7 studies with a total of 14,438 women comparing a trial of labour (attempted VBAC) with elective repeat caesarean delivery with respect to maternal blood transfusion.
They found mothers attempting VBAC had only about half the chance of needing a transfusion.
(The statistical terms are odds ratio 0.57; 95% confidence interval, 0.42-0.76)
Ref: Mozurkewich EL and Hutton EK. Elective cesarean delivery versus trial of labor: A meta-analysis of the literature from 1989 to 1999. AmJOG Nov2000;183(5):1187-1197.
Dr.David
DISCLAIMER:
This advice is of a general nature to help in decision-making. It
does not constitute recommended treatment for an individual. You must
consult your health care provider for individual
advice.