VBAC Less Risky Than Multiple C-Sections
By Tine Reese
June 15, 2010The National Institute for Health issued a report this week titled, Vaginal Birth After Cesarean: New Insights. The report presents evidence to support the choice of a trial of labor (TOL) as a safe option for women who have had previous c-sections.
The conclusion of the report states, “Each year 1.5 million childbearing women have cesarean deliveries, and this population continues to increase. This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans. Relatively unexamined contextual factors such as medical liability, economics, hospital structure, and staffing may need to be addressed to prioritize VBAC services. There is still no evidence to inform patients, clinicians, or policymakers about the outcomes of intended route of delivery because the evidence is based largely on the actual route of delivery. This inception cohort is the equivalent of intention to treat for randomized controlled trials and this gap in information is critical. A list of future research considerations as prioritized by national experts is also highlighted in this report.”
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As Dr. Linda Burke-Galloway says, “Most obstetricians know that convincing hospitals is another matter. Today, most hospitals will not allow VBACs unless the physician remains in the hospital during the patient’s entire course of labor. Since most physicians refuse to do so, a patient is often forced to have a repeat c-section.”
If you’ve been told that you must have a VBAC, that you won’t be allowed to attempt a vaginal birth at the hospital, you should get a second opinion and ask your care providers for evidence proving that a VBAC is medically necessary—not just defensive medicine. Chances are, if you speak with multiple care providers you will find that opinions vary and that you do have choices.
The Coalition to Improve Maternity Services (CIMS) issued their new evidence-based paper titled, The Cesarean Section Fact Sheet & Mother’s Checklist. CIMS is concerned about the dramatic increase and ongoing overuse of cesarean section. The surgical procedure poses short- and long-term health risks to mothers and infants, and a scarred uterus poses risks to all future pregnancies and deliveries. For these reasons, CIMS recommends that cesarean surgery be reserved for situations when potential benefits clearly outweigh potential harms. This document is a must-read for all expectant families!
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