Dear Dr David,
I am a mother of 2 healthy babies born by c/section - my youngest now being 3 years old.
I am 6 weeks pregnant and am considering a VBAC.
I have read through so much information and have been told so many different facts. Everything I read is either completely left wing or completely on the right.
What is the risk increase after 2 sections compared to 1 section. What can go wrong after 2 sections that wouldn't after 1?
If I was your patient, what limitations would you suggest? Some articles that I have read insist that it would be foolish to deliver anywhere else other than a large teaching hospital. Then access to a quick c/section is available. Is this really necessary? - it's not exactly what I had in mind.
Any suggested reading that is factual would be greatly appreciated!!
Thanks
Isobel.
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Dr David
Moderator Posted 11 May, 2001.
Isobel
It is not too unusual in life to get different interpretations of the same data from different people depending on how they look at it. Is the cup half full or half empty?
It may be useful for you to look at the original data to make up your own mind about VBA2C. I'll put below the Pubmed references to the key studies on VBA2C. You can only download the abstract or summary of the article, but I'd suggest you take these to your obstetrician and ask her/him to get you a copy of the whole paper. Another way would be to visit your local library and they may be able to help. Henci Goer's book 'Obstetric myths versus research realities' has a section on how to read research papers.
A general summary of the difference between VBA1C and VBA2C would be that women who try for VBA2C have a lower chance of vaginal birth (75% vs 83% [Miller's paper]) when compared to VBA1C, and have a higher chance of uterine rupture (1.8% vs 0.6%). Less women with 2 previous caesars try for, or allowed to, labor (54% vs 80%). In that paper, there was one rupture related baby death out of the 1586 women with 2 previous caesars who tried for vaginal birth compared to 2 out of 10,880 women with one previous Caesar. There is nothing extra that can go wrong after two rather than one Caesar.
To show how a different "spin" can be put on these same data, you could equally write it as "3 out of 4 women with 2 previous caesars who tried for vaginal birth in the quoted study had a vaginal birth. 98.2% of them did not have a ruptured uterus."
There is some evidence (Leung et al see below) that "decision to delivery time" is an important determinant of whether a baby survives uterine rupture (most do) . I would suggest that a large teaching hospital may not necessarily have a quicker decision to delivery time than a smaller hospital, and that the time taken to make the decision is also a factor.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8041542&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10521745&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8018637&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3425654&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8238154&dopt=Abstract
I cannot comment on specific limitations for a particular person. As has been said, no course of action can be said to be absolutely "safe". You need to decide what is the right option for you.
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.