Women's Options in Maternity Care & Birth

The following sections provide information on cesearean delivery as well as vaginal birth after cesarean (VBAC).

Animation of a Cesarean

Cesarean Section

Vaginal Birth After Cesarean

1. When a cesarean is necessary, it can be a life-saving technique for both mother and infant.

2. One in four births is a cesarean, with some hospitals reporting as high as one in two. This represents a 400% increase in less than 15 years. This cesarean rate increase has not led to an improvement in the infant mortality and morbidity rates but instead has put mothers and babies at greater risk. Rates began to fall in the mid-1990s, but are rising again in the new millennium.

3. Vaginal Birth After Cesarean (VBAC) is safer for both mother and infant, in most cases, than is routine repeat cesarean, which is major surgery.

4. The risk to your infant from the very low incidence of uterine rupture (less than 1%) is much less than the risk to your infant from respiratory distress as a result of a scheduled cesarean.

5. One-half of all cesarean women suffer complications, and the maternal mortality rate is at least two to four times that of women with vaginal births. Approximately 180 women die annually in the United States from elective repeat cesareans.

6. Many indications for cesarean can and should be questioned, including cephalopelvic disproporton (CPD or baby too big, pelvis too small), dystocia, failure to progress, breech, etc.

7. According to the World Health Organization, "Countries with some of the lowest perinatal mortality rates in the world have cesarean rates of less than 10%. There is no justification for any region to have a rate higher than 10-15%."

What is a VBAC?

It is a vaginal birth after one or more cesareans. More than 80% of women will be able to have a VBAC.

According to Midwifery Today (Winter No 36 page 47) ACOG recently updated their opinion on VBAC and stated "VBAC is safer than repeat cesarean and VBAC with more than one previous cesarean does not pose any increased risk". The Guidelines can be obtained from: ACOG, 409 12th St SW, Washington DC 20024.

Why would I want a vaginal birth?

There are many reasons that you may want a vaginal birth after a cesarean. Some may be medical and some may be emotional. Others may be financial or in terms of recovery. Here are some brief lists of the benefits to the mother and baby of a vaginal birth.

Mother:

• Prevention of Death from surgery
• Prevention of lesser complications from surgery
• Prevention of blood loss
• Prevention of infection
• Prevention of injury (bowel, urinary tract, etc.)
• Prevention of blood clots in the legs
• Prevention of feelings of guilt or inadequacy that surgery sometimes causes
• Breastfeeding is generally easier after a vaginal birth
• The cost of a vaginal birth is about $3,000 less

Baby:

• Prevention of Iatrogenic Prematurity (meaning surgery was done, because of an error in guessing a due date)
• Reduction in the cases of Persistent Pulmonary Hypertension
• Labor prepares the baby for extrauterine life
• Prevention of surgery related fetal injuries (lacerations, broken bones)
• VBAC results in fewer fetal deaths than elective repeat cesareans

What about rupture of the uterus?

This is a common fear among women who have had a previous cesarean. Most of this fear dates back to when the incisions of the original cesarean were of the classical variety (vertical incisions), nowadays most incisions are the low transverse type. There are two types of uterine rupture: complete and incomplete.

Complete uterine rupture is very unlikely today, for a variety of reasons. One is that when we use pitocin, if needed, during a labor, we regulate the amount that goes in. In other times it was given IV to a woman and allowed to flow freely. These have also decreased due to some obstetrical practices being abandoned, like high forceps, internal version, etc. And the final reason is because of the rarity of the classical incision. A complete rupture occurs in much less than 1% of women attempting VBAC.

Incomplete rupture occurs about 1-2% of the time. However, usually these women are asymptomatic, and neither mother or infant require any assistance.

Golan published a study in 1980, where there were 93 ruptures of the uterus. 61 of those ruptures occurred in a normal uterus (never had an incision), and 32 of them had had previous incisions. There were 9 maternal deaths from the ruptures, but they were all from the group that had not had previous cesareans.

From Childbirth.org

Recommended Reading:

The VBAC Companion: The Expectant Mother's Guide to Vaginal Birth After Cesarean  -  (1997) by Diana Korte

PLEASE NOTE:  All information expressed on the WOMB website and in our workshops, sessions, and/or consultations is to be used for informational purposes only.  We are not providing medical advice as we are not licensed medical professionals.  Therefore, we cannot be held liable for unforseen outcomes.