Despite the fact that the risks to mother and baby from a VBAC (vaginal birth after cesarean) have not changed over the last 10 years, fewer care providers are encouraging mothers to have a VBAC.
Instead the "norm" is to assume that the mother with a previous cesarean will have the rest of her babies via cesarean. In some cases, the mother who may want to try for a VBAC is frequently told that it is not as safe as doing a repeat cesarean and even that a VBAC is riskier to her and to her baby. New research sheds light on the fact that repeat cesareans may actually cause more complications with babies.
The Truth about VBAC Safety
While the reality of uterine rupture with a VBAC is real, the risks are actually quite low - between 1-2% of all VBAC births. In other words, 98-99% of all mothers who plan to have a VBAC will not have a uterine rupture. Even more promising is that new techniques to evaluate the thickness of the previous uterine scar can help reduce the mother's risk of a uterine rupture.
The safety of VBAC births are rarely explained to expectant mothers in these terms. In fact, the statistics are often exaggerated and mothers are made to feel that they are being selfish or uncaring about their babies if they desire to have a VBAC.
Complications for Mothers with a Repeat Cesarean
One of the problems with the issue of VBAC versus repeat elective cesarean is that parents rarely have full disclosure about the risks to mothers and babies after cesareans. Studies have shown that the risk of complications such as blood clots are 52% greater in mothers after a cesarean birth. Because there is a higher chance of excessive bleeding as a result of repeat cesareans, the mother has a 92% greater chance of needing a blood transfusion.
One recent study also showed that the mother's risk of stroke within the first year after her baby is born was approximately 1.5 times greater after a cesarean.
However some of these complications have been down-played since repeat cesareans were thought to be "safer for babies." New evidence shows that this belief is not based on fact.
Complications for Babies with a Repeat Cesarean
The mother's body is made to give birth vaginally, so it is no surprise that babies also do not fare as well after cesareans. Because babies do not have the benefit of having fluid and mucous squeezed out during the journey through the birth canal, they are more likely to have breathing or respiratory problems.
In fact, researchers have recently discovered that babies born after a repeat cesarean were more than twice as likely to be admitted to the NICU and require oxygen as the babies born after a VBAC.
What You Can Do if You Want to Have a VBAC
It is crucial that parents who would like to plan for a VBAC find not only a supportive care provider but inquire about the policies at their chosen place of birth. Some places of birth do not allow a trial of labor for VBAC mothers due to the lack of anesthesia coverage or for other reasons. Also know that your choices of labor induction will be different since pitocin is rarely used for VBAC mothers. Write a birth plan, plan to be mobile during labor and hire a doula to guide you through the labor and birth process.
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