Monday, September 22, 2008

VBACs on the decline

Today’s Ledger-Enquirer includes the third story in the series I wrote examining the rising Caesarean section rates here and across the country. Many experts agree that one of the biggest factors in the recent spike in Caesarean rates is the increasing reluctance of doctors to allow women to attempt VBAC – or vaginal birth after Caesarean. Today’s story looks at what’s driving that trend and how some determined women are managing to buck it.

Please consider sharing your own birth story on the mom2mom forum. To launch the discussion, Elaine Mills, chapter leader for the International Cesarean Awareness Network of Atlanta, shares her story of the “cascading interventions” that led to a Caesarean in her first pregnancy, along with the story of her most recent VBAC (or vaginal birth after Caesarean) with her third child after two prior Caesareans.

Here’s a list of the risks and benefits associated with VBAC, according to the American College of Obstetricians and Gynecologists July 2004 Practice Bulletin:

Benefits of VBAC over repeat Caesarean

Generally, successful VBAC is associated with:
Shorter maternal hospitalizations
Less blood loss and fewer transfusions
Fewer infections
Fewer thromboembolic events
Can avoid risks of multiple Caesarean deliveries including an increased risk of placenta previa and accreta

Risks of VBAC
A failed trial of labor may be associated with major maternal complications such as:
Uterine rupture
Operative injury
Increased maternal infection and the need for transfusion
Neonatal morbidity also is increased with a trial of labor
Although the incidence of perinatal death is low (generally less than 1 percent), it is more likely to occur during a trial of labor than an elective Caesarean

ACOG also says that more research is needed to help assess the risks and benefits of VBAC: The bulletin says “Despite thousands of citations in the world’s literature, there are currently no randomized trials comparing maternal or neonatal outcomes for both repeat cesarean delivery and VBAC. Intead, VBAC recommendations have been based on data from large clinical series suggesting the benefits of VBAC outweigh the risks in most women with a previous low-transverse cesarean delivery. Most have been conducted in university or tertiary-level centers with full-time in-house obstetric and anesthesia coverage. Only a few studies have documented the relative safety of VBAC in smaller community hospitals or facilities where resources may be more limited.”

Any opinions on ACOG’s assessment of VBAC safety? Weigh in with a comment.

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