VBAC Safety
By momofsix
January 29, 2008
A Vaginal Birth After a Cesarean (VBAC) can be hard to come by these days, as lawsuits and malpractice insurance escalate. Many women are told that a VBAC is impossible, citing safety reasons. Uterine Rupture is the most commonly talked about complication that can occur with a VBAC, but evidence has shown that the risks of uterine rupture are small.
In several studies, the uterine rupture rate has been shown to be about 0.6%, or about 6 out of 1,000 women. Most of these ruptures are not catastrophic, but perinatal mortality does occur in about 0.018% of uterine rupture cases. Or, about 18 out of 10,000 VBACs will end in a fatality caused by a rupture of the uterus.
To put this in perspective, we should look at the infant mortality rate for the
Some measures that can be used for a safer VBAC:
Go into labor on your own.
When induction methods are used, the contractions are harder, stronger and longer than normal contractions, which puts added stress on the uterine scar. Most medical institutions now strictly forbid induction of labor, but some do still practice it, regardless of the evidence that clearly shows how dangerous it can be.
There is no clear evidence to suggest that going past your due date is more dangerous than delivering before. Most women are perfectly safe delivering before 42 weeks, though some care providers will prefer non-stress tests and bio-physicals to check the fetal heart tones and amniotic fluid present.
If your care provider wants you to go into labor before 42 weeks, ask them what evidence suggests that delivering before 42 weeks is better?
Allow enough time to pass for birth.
Instead, natural methods of labor augmentation can be used, like nipple stimulation, walking and squatting.
A first vaginal birth is just like any other first vaginal birth; they take time. Your doctor shouldn’t dictate how much time your body needs to go deliver your baby. Many hospitals are interested in emptying beds and turning rooms, so you have to stand up for yourself and your birth, and insist that they wait.
Be Healthy
Think of labor as a marathon you have to prepare for. For any marathon, you’ll need to stay in excellent shape.
And remember that anything you eat yourself, you’re feeding your baby. If you wouldn’t feed it to your 2 year old, why would you feed it to your unborn child? This includes trans fats, fast food, junk foods of all kinds and alcohol. This will also ensure that you get the required nutrients and avoid unhealthy foods.
Labor and Birth in Water.
If you are able, consider birthing in water. It lowers blood pressure and increases amniotic fluid. It can also speed labor along, sometimes cutting in half the duration of the first stage of labor.
Intermittent Fetal Monitoring
Instead of EFM, intermittent fetal monitoring can be used, where a hand-held Doppler device allows the care provider to listen to the heart rate along with a mother’s contraction. It is quite obvious when women are having contractions, and a machine doesn’t need to announce it.
Intermittent monitoring can be done every 30 minutes throughout labor, and more often as the 2nd stage of labor approaches. Some care providers prefer to listen more often, which is also fine if the mother is comfortable with it.
The important thing to remember is that variations of the baby’s heart rate are normal, what is not normal is if the heart rate does not recover in between contractions. This is when fetal distress may be evident.
Labor Naturally
Epidurals come with their own risk, which include insufficient pain relief, maternal fever, lower heart rate, fetal distress, longer labor and inadequate ability of the mother to push during the 2nd stage of labor.
Natural labor (unmedicated) is often a satisfactory alternative for women. There are many methods for coping with pain during birth, including the Bradley method, Hypnobabies, Hypnobirth and Lamaze. A doula can also be an important component of a natural labor, since they have been shown to lower the cesarean, epidural and instrumental delivery rates. And, more mother’s have a positive birth experience if they have a doula at their side.
What makes you a VBAC candidate?
A lower-transverse uterine incision, or a “bikini cut.” The classical, vertical incisions have much higher rupture rates, and are not recommended for VBAC.
Be in good general health, without serious medical complications.
What still makes you a VBAC candidate?
Post-dates. Just because you hit the 42 week mark does not mean that you need to sign up for a repeat cesarean. It is an option, but waiting for labor to start is also an option.
Macrosomia (big baby). The
Oligohydramnios (low amniotic fluid). The uterus is not a sealed vessel, and water can be added to it. If oligohydramnios is suspected the mother can drink 80+ ounces of water per day, and then retest. This is just one method of increasing the amount of amniotic fluid in the womb.
Gestational Diabetes. GD can make babies bigger, and more prone to complications, but those can be watched along with maternal blood sugars. GD may make VBAC more difficult to achieve, but it in itself is not an indicator of disqualifying for VBAC.
Homebirth. Giving birth at home is absolutely possible, and often safer, than giving birth in a hospital. Close distance to nearest hospital, competent care provider (or knowledgeable partner if planning unassisted), and suitably clean birthing environment are all that need be present for a successful homebirth after a cesarean (HBAC).
In the end, women must look at the options available to her, the research she finds, and the results she hopes to accomplish. For some, having a VBAC isn’t as important as having control over the birth date or maternity leave; in those cases, a VBAC and the safety of it is irrelevant. For others, the implications of a repeat cesarean are daunting, and the relative safe vaginal birth can be very rewarding. In those cases, it should be encouraged.
No birth is without risk. All situations must be evaluated to find the best possible conclusion for both mother and baby.
This is for informational purposes only, and is not meant to replace the advice of a medical professional.
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