Clear Light Holistic Midwifery

VBAC

Why Have a VBAC? Vaginal Birth After Cesarean

Recently I invited two women who gave birth by cesarean section to talk about their birth experience. The first woman was very well prepared for her birth. She always brought a little notebook to her prenatal visits, making sure she did not forget something important the doctor said. She planned to have a vaginal birth in the hospital without intervention or medication. "I was laboring along fine." Suddenly the hospital staff approached her, and told her she was being taken for an emergency c-section. She was shocked. "I thought I was doing a good job, and things were going well." She followed instructions from that point on. Sometime later, much later, they brought her a baby. "I did not even feel like this baby was mine. They could have brought me any baby." Maternal-infant bonding happens in the first hour after the birth. Now at 6 weeks postpartum, she has bonded with her baby, and they have a close relationship. "It was difficult for the first few weeks." She has feeling of sadness and loss, even though she has a healthy baby who is doing well. "I know I should be thankful to have a healthy baby, and I am, but I missed the whole birth." She is grieving the loss of this experience.

The second woman recalls a 3-day labor that ended in cesarean section. The baby was "facing the wrong way and the head was tipped." He weighed 9lbs 14 oz, and was "so big." She was very tired, and hearing that she was going to have a cesarean section was not a shock. She doubted that she had the energy needed to push the baby out. After the birth she recalled, "I was so out of it." They brought a baby in a bassinette, and put it near my bed. I knew this was our baby" (her husband is Afro-American and the baby was very dark), but if not for his color, I would not have known." She did not have problems with nursing, as many women do who are not given time with their babies immediately after birth. Later she spoke of a very long, and difficult recovery time. Her sister-in-law gave birth a week before she did. "She was back to normal and doing everything. I was having a difficult time just getting around." She hopes to have a VBAC for her next birth because she knows, "I can do it," and she does not want major surgery again.

Is VBAC Safe?

VBAC is safer than having another cesarean surgery. A tear of opening in the uterus (womb) occurs in 5-10 out of every 1,000 low-risk women who try for a VBAC. This is a 0.5% - 1.0% rate of uterine rupture.

As the rate of VBAC has declined in recent years, the maternal mortality rate has risen due to an increased number of cesarean deliveries.

1995	7.1 (per 100,000 births)
2004	13.0
2007	17.0

The neonatal mortality rate was higher among infants delivered by cesarean.

Newborn risk after cesarean delivery = 1.77 per 1,000 births
Newborn risk after vaginal delivery = 0.62 (about one third the risk).

The re-hospitalization rate of mothers within 30 days after cesarean surgery is higher as compared with rates of re-hospitalization after vaginal delivery. Reasons for re-hospitalization might be for poor wound healing, infection, complications due to injury to the bladder or uterus during surgery.

Re-hospitalization rate after c-section = 19.2 of 1,000 women
Re-hospitalization rate after vaginal delivery = 7.5 of 1,000 women.

Benefits of VBAC vs planned cesarean birth

Faster healing time
Shorter hospital stay
Less chance of blood transfusion
Less risk of infection after delivery
No chance of problems caused by surgery (infection, bowel/bladder injury, blood loss)
Less risk the baby will have breathing problems
Quicker recover time (no pain from surgery)
Greater chance of having a vaginal birth with subsequent births

Risks of VBAC

A tear or opening in the uterus (womb) occurs in 5 to 10 women out of every 1,000 low-risk women who try to have a VBAC (0.5% - 1.0%).

Risks to mother if there is a tear in the uterus:

Blood loss that may require transfusionDamage to the uterus that may require a hysterectomy
Damage to the bladder
Infection
Blood clots
Death, which is very rare

Risks to the baby if there is a tear in the uterus:

Brain damage
Death
Not all tears in the uterus harm the baby. About 10% of the time the baby is harmed when the uterus tears. This means 5 to 10 of every 10,000 VBAC tries will suffer brain damage or death (0.05% to 0.1%).

Additional risks:

Labor is induced (does not start on its own)
More than 1 previous cesarean section
Less than 18 months since your last cesarean delivery
Need for medicine during labor to increase your contractions

It is likely that 60-85% of women who try to have a vaginal birth after previous cesarean section will be successful.

Bangor area hospital VBAC rate:	1.4%
Clear Light Holistic Midwifery VBAC rate:	7.0%
Clear Light Holistic Midwifery VBAC success rate:	100% to date (01/2009)