VBAC Can Be A Safe Alternative to Repeat C-Section
An NIH Panel this week is encouraging physicians and pregnant women to discuss all delivery options, including a VBAC, or vaginal birth after cesarean section or c-section. The group also urged professional societies to revisit current VBAC guidelines, malpractice concerns, and to undertake additional research about both vaginal birth and c-section risks.
The panel is concerned that pregnant women have limited access to both clinicians and facilities that will be willing to offer a trial of labor after a previous cesarean. Even those at low risk are often not given the option because of so-called VBAC bans. Prior to 1980, VBACs were discouraged because of the widely held belief that “once a c-section, always a c-section.”
Rates for VBAC increased after a consensus statement was issued, until 1996 when they began to decline again. In 1999, the American College of Obstetricians and Gynecologists issued guidelines that VBACs should only be attempted in hospitals equipped for immediate emergency surgery. Today, VBAC rates are less than 10% of all births, while at the peak women had natural births 28% of the time in subsequent pregnancies.
Medical providers point to safety as their chief concern about attempting VBAC. Research has shown that a trial of labor can be successful in nearly 75% of cases and that maternal mortality is lower for those women, regardless of the final outcome of vaginal birth or c-section.
Cesarean section rates have increased over the past 15 years, according to Dr. F. Gary Cunningham, panel chair and chair of the obstetrics and gynecology department at the University of Texas Southwestern Medical Center in Dallas. Today, nearly one-third of all births are by c-section. At times, it is patient choice because of scheduling convenience, the desire to avoid labor pain, a fear of a failed trial of labor, and the desire for surgical sterilization at the time of delivery.
For some women, the desire to attempt labor is based on the wish to include their partner’s involvement in the delivery, the belief that a vaginal delivery can be deeply empowering, enhanced opportunity for maternal-infant bonding, greater ease in establishing breast feeding, and an easier recovery.
Although the panel agrees on more research, in general, VBAC is a safe alternative for women who have had one prior c-section performed through a transverse incision, the most common kind. Women at higher risk are those having had more than one c-section or one performed using a different incision technique, carrying multiples, having a large baby or one that is not in the normal position, being obese, or having a chronic health condition such as high blood pressure or diabetes.