New Study Looks at Multiple VBAC Outcomes
By Danell Swim
February 4, 2008
A study just released this year looks at the success rates, and mortality rates of VBAC’s, and future VBAC’s. It shows that the success rate for a first time VBAC is about 63%, but a second VBAC has a success rate of 87%, and the uterine rupture rates are nearly cut in half after that first VBAC.
This will be good news to many women planning large families after a cesarean, since most studies looking at the complications arising from multiple cesareans show that the risks dramatically increase with each cesarean.
This study should be the beginning of a change regarding how hospitals treat VBAC patients. Maybe with this sort of evidence, they will stop the “once a VBAC, always a VBAC”process, and allow VBAC’s regardless of staffing issues for women who’ve had at least one prior VBAC.
OBJECTIVE: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.
METHODS: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.
RESULTS: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
CONCLUSION: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.
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