ICAN of Richmond

Supporting & Educating Birthing Families

 

Risk of Uterine Rupture with Low Transverse Uterine Scars* Revised 10/14/2002

Number of Previous Cesareans

Successful VBACs

Rupture Rate

Perinatal Mortality

10,880 Planned VBACs with one prior scar

83%

0.6%

0.018%

1,586 Planned VBACs with two prior scars

76%

1.8%

0.063%

241 Planned VBACs with three prior scars

79%

1.2%

0

Source: Miller, D. A., F. G. Diaz, and R. H. Paul.1994. Obstet Gynecol 84 (2): 255-258

 

 

 

 

 

 

*This study included women with breech babies and twins and use of oxytocin

This chart came from www.vbac.com .

Breaking News

 

Vaginal Birth After Cesarean or Repeat Cesarean?

 

VBAC

Repeat Cesarean

 

  • Uterine Rupture (.5% chance)

Of that, about 10% chance baby will suffer some damage

 

 

  • Uterine Rupture (.2% chance)

·        Possible Effects of Uterine Rupture

           Blood loss

           Hysterectomy

           Infection

           Damage to bladder

           Very rarely, death.

·        Same effects of Uterine Rupture as with VBAC.

 

 
  • Blood loss            

·        Faster recovery time

·        Increased internal scar tissue

  • Shorter hospital stay (or none at all if homebirth)

·        Infection

            (50 times more common)

  • Less chances of infection, blood transfusions

·        Injury to organs/Surgical Mistakes

  • Greater chance of future vaginal births

·        Anesthesia Mistakes

 

·        Pulmonary Embolism

 

·        Later reproductive problems

           Ectopic pregnancy, miscarriage, infertility

 

·        Placenta accreta

           1 in 1,000 with 1 prior cesarean

           1 in 100 with more than 1 prior cesarean

 

·        Placenta previa

           4 times greater with 1 prior cesarean

           7 times greater with 2-3 cesareans

 

·        Death is 5-7 times more likely

           (Source-CIMS)

 

·        Baby risks prematurity

 

·        Breathing problems for baby

 

·        Baby has 2% chance of getting cut by the surgeon’s blade

 

·        Breastfeeding and Bonding more difficult for both mother and baby.

 

 

Why is the decision between VBAC (vaginal birth after cesarean) and repeat c-section important?

If you have had one or more cesareans, your decision about whether to plan a VBAC ("vee-back") or a repeat cesarean section can have far-reaching consequences for you, your baby, and any future pregnancies. Click here on the Childbirth Connection website for more information.

 

Studying the Research: VBAC or Repeat Cesarean Resources

Henci Goer's Normal Birth Forum on VBAC

 

Know your Rights to VBAC. Are you being offered the full range of information besides liablity concerns?

ACOG. Informed refusal. Committee Opinion No 237, June 2000.

"Once a patient has been informed of the material risks and benefits involved with a treatment, test, or procedure, that patient has the right to exercise full autonomy in deciding whether to undergo the treatment, test, or procedure or whether to make a choice among a variety of treatments, tests, or procedures. In the exercise of that autonomy, the informed patient also has the right to refuse to undergo any of these treatments, tests, or procedures. . . . Performing an operative procedure on a patient without the patient's permission can constitute 'battery' under common law. In most circumstances this is a criminal act. . . . Such a refusal [of consent] may be based on religious beliefs, personal preference, or comfort."

 

Learn more about cesarean prevention and VBAC

Trial of Labor After Cesarean (TOLAC)

Formerly Trial of Labor Versus Elective Repeat Cesarean Section for the Woman With a Previous Cesarean Section
American Academy of Family Physicians

Executive Summary

The American Academy of Family Physicians Commission on Clinical Policies and Research convened a panel to systematically review the available evidence on trial of labor after cesarean delivery (TOLAC) using the Agency for Healthcare Research and Quality Evidence Report on Vaginal Birth After Cesarean (VBAC). The panel’s objective was to provide an evidence-based clinical practice guideline for pregnant women and their families, maternity care professionals, facilities, and policy-makers who care about trial of labor and maternity care for a woman with one previous cesarean. The recommendations are as follows:

Recommendation 1: Women with one previous cesarean delivery with a low transverse incision are candidates for and should be offered a trial of labor (TOL). (Level A)

Recommendation 2: Patients desiring trial of labor after previous cesarean (TOLAC) should be counseled that their chance for a successful vaginal birth after cesarean (VBAC) is influenced by the following: (Level B)

Positive Factors (increased likelihood of successful VBAC)
Maternal age <40 years
Prior vaginal delivery (particularly prior successful VBAC)
Favorable cervical factors
Presence of spontaneous labor
Nonrecurrent indication that was present for prior cesarean delivery
Negative Factors (decreased likelihood of successful VBAC)
Increased number of prior cesarean deliveries
Gestational age >40 weeks
Birth weight >4,000 g
Induction or augmentation of labor

Recommendation 3: Prostaglandins should not be used for cervical ripening or induction as their use is associated with higher rates of uterine rupture and decreased rates of successful vaginal delivery. (Level B)

Recommendation 4: TOLAC should not be restricted only to facilities with available surgical teams present throughout labor since there is no evidence that these additional resources result in improved outcomes. (Level C) At the same time, it is clinically appropriate that a management plan for uterine rupture and other potential emergencies requiring rapid cesarean section should be documented for each woman undergoing TOLAC. (Level C)

Recommendation 5: Maternity care professionals need to explore all the issues that may affect a woman's decision including issues such as recovery time and safety. (Level C). No evidence based recommendation can be made regarding the best way to present the risks and benefits of trial of labor after previous cesarean delivery (TOLAC) to patients.

AAFP Policy Action March 2005 -- Printed July 2005
Copyright© 2005 American Academy of Family Physicians

Forced Cesarean? VBAC Denied?

You have the right to advocate for the type of birth you want. Did your provider offer VBAC as an option? Were you only told about the risks of VBAC but not a repeat cesarean? Was your request for VBAC denied? Here are some steps you can take:

1. Contact us! We will help you organize the resources you need to get the birth that you want.

2. Read VBAC Bans Q & A

3. Read Having a Baby? 10 Questions to Ask

4. Sign up for the national ICAN Support Group List or ICAN of Richmond's local list ICAN BIRTH.  

5. Donate to ICAN of Richmond or Become a Member.

Normal birth is being threatened for us and our daughters. Help us by subscribing to the Clarion! ICAN has always consisted of people just like you. The Clarion is an excellent source of up-to-date information and support.
In addition to receiving the newsletter, you will be supporting an all-volunteer international organization, which educates families in need of birth, cesarean and VBAC information. We also reach interested professionals and groups with similar goals for birth and health. ICAN is the voice to end the practice of unnecessary cesareans worldwide.
Women and families in need contact the ICAN office daily, looking for answers, looking for help.
Please add ICAN to your list of tax-deductible annual contributions. ICAN exists solely by the support of numerous private citizens who recognize the need for an organization like ours.

For further info contact us at icanofrichmond@yahoo.com