Risks of VBAC vs Repeat C/Section

[Tracie]

I have not had a caesarian and therefore am not planning a VBAC so I cannot talk from personal experience but I do talk to lots of women who are considering VBAC and I know that they come to places like Bub Hub to find info and read about other mum's experiences.

As always I want to state that each mum has the right to choose whatever option feels right for them but in order to do that confidently, you must have the most up-to-date information with regard to the risks and complications of either choice.

I have seen a few posts lately where repeat c-section is described as being the safest option for mum and baby and VBAC is described as too risky or even dangerous. A repeat C-section is by no means risk-free and much of the research available today concludes that a VBAC is actually just as safe or safer for mum and baby.

So, in the interest of ensuring access to best evidence with regards VBAC vs Repeat C-Section, I am posting this extract (there is ALOT more info than this) from another website and a link to the site. It has absolutely fantastic evidence based information regarding all aspects of pregnancy and childbirth and all mums would benefit from adding it to their favourites list.....

http://www.childbirthconnection.org/...e.asp?ck=10210

This page presents results of recent systematic reviews that can help women compare risks of planned vaginal birth after cesarean (VBAC) and of planned c-section (see references at end of page). While more high-quality studies are needed, a large body of research already exists and sheds light on these questions for those who need guidance now.

When deciding whether to plan a VBAC or a repeat cesarean, it is important to understand the full range of risks to you and your baby. This means comparing the short- and long-term risks of cesarean surgery and risks of accumulating cesarean surgery scars to mothers and babies on the one hand, to the risk that the uterine scar will give way (uterine rupture) and lead to problems and a few risks that are worse for vaginal birth generally.

Even if you do not plan to have more children, you should be aware of risks of multiple cesarean scars to future pregnancies and babies. Many women change their mind and decide to become pregnant again or continue with unplanned pregnancies.

What is the bottom line?
If you do not have a clear and compelling need for a cesarean in the present pregnancy, having a VBAC rather than a repeat c-section is likely to be:

safer for you in this pregnancy

far safer for you and your babies in any future pregnancies

When thinking about the welfare of your baby in the present pregnancy, there are trade-offs to consider: VBAC has some advantages, and a repeat c-section has others. You can learn more below.

KEY MESSAGES ABOUT VBAC VS. REPEAT CESAREAN SECTION:

Despite limitations of the best available research, the following conclusions seem clear:

Scar giving way: The scar is more likely to give way during a VBAC labor than in a repeat c-section; for most women (exceptions noted below), the added risk of the scar giving way is about 27 in every 10,000 VBAC labors. In other words, nearly 400 women would need to experience the risks involved with repeat c-section to prevent one uterine rupture during a VBAC labor.

Death of baby: While the scar giving way poses a threat to the baby, the added risk that the baby will die from a problem with the scar during a VBAC labor, compared with women planning repeat c-sections, is about 1.4 in every 10,000 VBAC labors. In other words, over 7100 women would need to experience the risks involved with repeat c-sections to prevent the death of 1 baby due to uterine rupture.

Hysterectomy in mother: If the scar gives way, some women have a hysterectomy The added risk of needing a hysterectomy from this cause is about 3.4 in every 10,000 VBAC labors, when compared with women planning repeat c-sections. However, considering risk for hysterectomy from all causes, women who plan a VBAC are not more likely to experience an unplanned hysterectomy than women planning repeat c-section.

Concerns about specific risks: The following factors do not increase risk of the scar giving way during labor:

type of uterine scar not known
low vertical uterine incision for prior c-section
baby estimated to be large, and to weigh more than 4,000 grams
pregnancy goes past 40 weeks.

Concerns about other risks: The following factors have not been shown to increase the risk of the scar giving way, but too few cases have been studied to be confident:

twin pregnancy
use of external cephalic version: turning a baby who is positioned buttocks- or feet-first (breech) to head-first position by manipulating the woman's belly
Infection: Women planning c-sections are more likely to develop infections than women planning VBACs.

Multiple scars in uterus: Accumulating c-section scars increase risk for experiencing a number of serious problems relating to future pregnancies and births. These include:

scar rupture in a subsequent labor
ectopic pregnancy: embryo develops outside uterus
placenta previa: the placenta grows over the cervix
placental abruption: the placenta separates from the uterus before baby is born
placenta accreta: the placenta growing abnormally into or even through the uterus.

What are some concerns about risks of c-section compared with vaginal birth?

When weighing VBAC vs c-section, the focus is often on potential problems with the uterine scar in labor or on problems associated with accumulating scars. But this results in an incomplete picture because it overlooks other risks that also differ between vaginal birth and cesarean section. Summarized here are some of the many extra risks associated with cesarean surgery as well as the few advantages. (In Best Evidence: C-Section, you can find a detailed comparison of risks of cesarean and vaginal birth, including how likely these problems are to occur.)

Most of what we know about these risks comes from studies of cesarean in general, not planned c-section. Available research suggests that some of these risks may be lessened when the c-section is planned. The next question: What are some ways that a planned c-section may differ from an unplanned c-section? points to adverse effects where research finds differences in risk.

As you consider these, keep in mind that on average, 3 out of 4 women who labor after a c-section will give birth vaginally with care that encourages and supports VBAC (and fewer than 1 in 100 will experience the scar giving way). Even in cases where women scored 0 to 2 on a scale where 10 indicated greatest likelihood of vaginal birth, half gave birth vaginally.

Physical problems for mothers: Compared with vaginal birth, c-section increases a woman's risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction (due to scarring and adhesions from the surgery), to much more common problems such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.

Hospital stays: If a woman has a c-section, she is more likely to stay in the hospital longer and to be re-hospitalized.

Emotional well-being: A woman who has a c-section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth.

Mother-baby relationship: A woman who has a c-section is more likely to have less early contact with her baby and initial negative feelings about her baby.

Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by c-section is less likely to be breastfed and get the benefits of breastfeeding.

Impact on babies: Babies born by c-section are more likely to:
be cut during the surgery (usually minor)
have breathing difficulties around the time of birth
experience asthma in childhood and in adulthood.

Impact on any future babies: A c-section in this pregnancy increases risk for babies in future pregnancies. Some research finds that babies who develop in a scarred uterus are more likely to:

be born too early (preterm)
weigh less than they should (low birth weight)
have a physical abnormality or injury to their brain or spinal cord
die before or shortly after the birth

What are some concerns about risks of vaginal birth compared with c-section?

C-section offers advantages in a few areas, primarily during the recovery period after birth. (Some practices used with vaginal birth, such as episiotomy, are associated with pelvic floor problems. It is wrong to conclude at this time that vaginal birth itself causes such problems. See the Pregnancy Topic Preventing Pelvic Floor Dysfunction.

A woman who has a vaginal birth is more likely to:

have a painful vaginal area in the weeks after birth
leak urine (urinary incontinence) (about 3 women per hundred still have a problem 1 year after birth)
leak gas, or more rarely, feces (bowel incontinence) (about 3 women per hundred still have a problem 1 year after birth)
Babies born vaginally have been shown to be at higher risk for a nerve injury affecting the shoulder, arm, or hand (brachial plexus injury) (usually temporary).

What are some ways that a planned c-section may differ from an unplanned c-section?

Continued.................

[Tracie]

Continued from previous post.....

A planned c-section offers some advantages over an unplanned c-section that occurs after labor is under way. For eg, there is a lower risk of surgical injuries and of infections. The emotional impact of a cesarean that is planned in advance appears to be similar to or somewhat worse than a vaginal birth. By contrast, unplanned cesareans can take a greater emotional toll. In addition, a woman planning repeat cesarean surgery would almost certainly be less likely to experience difficulty breastfeeding if she had breastfed before or to have negative feelings for her baby compared with a first-time mother having an unplanned cesarean. Nonetheless, a planned cesarean still involves the risks associated with major surgery. And both planned and unplanned cesareans result in a uterine scar, which increases risk for serious concerns for mothers and babies in future pregnancies, and for adhesion-relation problems in mothers at any time.

There is alot more info and research on the website...here is the link again.....

http://www.childbirthconnection.org/...e.asp?ck=10210

References
Guise J-M, Berlin M, McDonagh M, Osterweil P, Chan B, Helfand M. Safety of vaginal birth after cesarean: a systematic review. Obstet Gynecol 2004;103:420-9.

Guise J-M, McDonagh MS, Osterweil P, Nygren P, Chan BKS, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ 2004;329:159-65.

Hashima JN, Eden KB, Osterweil P, Nygren P, Guise J-M. Predicting vaginal birth after cesarean delivery: a review of prognostic factors and screening tools. Am J Obstet Gynecol 2004;190:547-55.

Lieberman E. Risk factors for uterine rupture during a trial of labor after cesarean. Clin Obstet Gynecol 2001;44:609-21. [Alone among references, this article is not a systematic review; it is included, however, as a well done review that addresses important questions for women facing the VBAC/repeat c-section decision.]

Childbirth Connection. Comparing risks of cesarean and vaginal birth to mothers, babies, and future reproductive capacity: a systematic review. New York: Childbirth Connection, April 2004. [The following study documents are available as PDF files from the Childbirth Connection website: description of methods and sources (including full bibiliography), list of main questions and outcomes (a table of contents for evidence tables), first file of evidence tables, and second file of evidence tables.]

[becca74]

This is brilliant Tracie, thanks for posting it

[mochridhe]

Great info!!

Thanks for posting!

[HouseOfBlues]

Thanks for the great info. Very informative.
I will be attempting a VBAC for #2

[dramabananas]

Excellent info and not easy to find!!!

Thanks

[Missus S]

Thanks for the excellent, well referenced info Tracie

[Briannabear]

Great info Tracie!

[jade21887]

Can I kiss you!!! Thanks for the great info, taking the info into my appointment on Friday. They cant turn me down for a VBAC in my eyes with all the information I have!

[Tracie]

Mwaaah!

Have a great appointment Jade!