VBAC – Vaginal Birth After Cesarean
Far too many women have unwanted and unnecessary cesarean sections in the United States. The national average is around 33% (Source: CDC) while the World Health Organization suggests that only 10-15% of c-sections are necessary (Source: WHO). Cesarean sections can save lives and are an important medical advancement, but statistically 20% of c-sections are avoidable and unnecessary. An unwanted cesarean can leave a woman with post-traumatic stress disorder, postpartum depression, and fear of child birth. More immediate ramifications may include surgical complications and difficulty with breastfeeding. Women who had previously been so excited for their child’s arrival and a happy delivery may have had their world turned upside down by their c-section, whether truly necessary or not.
Once there has been time to heal both physically and emotionally I think it is important for women to examine their birth experience and what occurred. Was there adequate support? Was there a true emergency? Did pain and/or induction medications play a role? Were the side effects of different interventions discussed before being implemented or before labor even began?
When you are ready to grow your family again after a c-section it is SO important to learn all of the facts on delivery after cesarean. Many women are unnecessarily scared in to or told they must schedule a repeat c-section. This is simply not true and actually is not the safest option in a healthy pregnancy. My intention in writing this post is not to offer any medical advice as I am not a licensed health professional but simply to help steer you toward some evidence based information on both the benefits and risks of a Vaginal Birth After Cesarean (VBAC) and Repeat C-Section (RCS) to discuss with your health provider. As a mom who had an unwanted cesarean with my first pregnancy due to breech presentation, I educated myself about both sides during my second pregnancy in order to make the best decision for myself and my family. The more you know, the better prepared you can be!
Get The Facts On VBAC
The best thing that you can do during your pregnancy, whether it be your first or your fifth, is to educate yourself. I have found ICAN – International Cesarean Awareness Network to be an amazing resource. They provide evidence based facts that may help you to avoid a cesarean. If you are lucky enough to have an ICAN chapter local to you then they are also a wonderful support network for women who have had cesareans, regardless of the desire to try for a VBAC or not. If you are simply looking for some short-term support after a c-section then you can find it in them as well.
Many women who are curious about VBAC are told by a healthcare provider that they can not do so because of the risk of uterine rupture. Current research shows that risk to be less than 1% in VBAC births, so it is not at all something that happens frequently and about 80% of women go on to VBAC successfully. In fact, the risk of uterine rupture even decreases with each subsequent VBAC after the first!(Source: ICAN)
I especially want to point out what ICAN shares about VBAC bans at hospitals. Though the hospital may have a “ban” the patient/pregnant mother always has the right to refuse any type of treatment/intervention, including a c-section, if it is an unwanted, unnecessary procedure. By law, the staff can not turn away a woman in labor and must care for her. Though I believe that having a fully supportive provider from the start is one of the most important factors in achieving a VBAC, if you find yourself in a sticky situation know that YOU make your own decisions regarding your birth once the time comes.
Though I had dreamed of having a VBAC I was still scared when I found out I was pregnant because I hadn’t done any research at that point. What really sealed the deal for me and got me excited about VBAC was the National Vital Statistics Reports on Births from the Centers For Disease Control and Prevention (CDC) on the Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History. There is no arguing with the statistics! As expected the lowest morbidity rates are seen in women with no cesarean history. VBAC is the safest means of birth as compared to both primary (meaning the cesarean in the first birth) and repeat cesarean with lower rates than of uterine rupture, maternal transfusion, unplanned hysterectomy, and ICU admission. Once I saw concrete numbers that having a VBAC is safer than having a repeat c-section I did not need any further convincing and was determined to find a provider who would support me.
One of the best resources I’ve found for VBAC information is the Birth Without Fear blog. Their post entitled “VBAC: What ACOG Really Says” dissects what the American Congress of Obstetricians and Gynecologists has to say about VBAC. If you are encountering backlash or fear tactics from your obstetrician then they are not even following their own governing body’s recommendations and you’d be better off finding a different and more supportive provider. You can absolutely switch providers at ANY point during your pregnancy if you do not feel as though you are receiving proper care.
For me, the choice was clear that VBAC was the right path and I was fortunate to have a supportive birth partner in my husband, an experienced and supportive VBAC OB practice, and a doula team who helped me prepare myself emotionally during my pregnancy and birth. I felt aboslutely amazing after my VBAC and couldn’t believe that “I DID IT!” after encountering a lot of social stigma and pressures from those who were not aware of the facts. Though I’ve obviously written this post from a VBAC supportive point of view, I truly believe that every woman has the right to choose whatever method of birth is best for her and I only hope to help get the facts out there so others can make informed decisions.
Quick VBAC Resources
- International Cesarean Awareness Network – http://www.ican-online.org/
- Birth Without Fear – http://www.birthwithoutfearblog.com/
- VBACfacts – http://www.vbacfacts.com
Hi there,
I too am going to have a VBAC December of this year. I have been researching nonstop about the pros and cons and recently attended a seminar on VBAC information and it was VERY informative. She actually posted the exact same graph you speak to in your article. While your information provided that VBAC ruptures only occur less than 1% which is true. I think you were interpreting the results of the CDC graph incorrectly. At first sight, it DOES seem like the graph is telling you that your uterus is likely to rupture up to 2x higher than during a VBAC, which is simply not accurate. Think about it, they are cutting into your uterus during the C-section, not rupturing. The graph states it’s 88.9 for repeat C section and 43.8 for VBAC. But you have to consider all births that let up to that repeat C section, this number takes in the total amount of ruptures, included those attemped VBAC’s. Great post though and I read as much as I can, but always check my sources.
I meant to say * two times higher during a repeat C-section, not VBAC.