VBAC (vaginal delivery after C-section) is when an expecting mother has previously had a child born by Cesarean section surgery and elects to have a child naturally in subsequent pregnancies. Doctors in years past would tell their patients that there was not a choice in having a natural birth after the C-section but, with the transverse, “bikini” cut that is now popular in the surgery, repeat surgery is not 100% necessary.
Scary Part First
The VBAC option has a rare risk of uterine rupture from the scarring from the previous surgery to extract a fetus. According to Julie Welischar, MD, and Gerald Quirk, MD, PhD (1) the risk of rupture is 1 in 100 births and a smaller percentage of that 1:100 might have to endure a hysterectomy, excessive bleeding, and/or the death of her fetus. However, these doctors claim that a large number of these ruptures are “asymptomatic” and the births are still successful.
In researching the VBAC options there are studies and support websites that seem to have huge discrepancies in the numbers of successful, non-rupturing VBAC births ranging from .2% up to 6% success rates. But the importance in those larger numbers seems to be the way that Cesarean surgeries are now being performed experimentally.The California College of Midwives (2) states that since the 1990s, doctors have widely begun using a “single closure” method of suturing which decreased post-birth “wrap up” time by a little over five minutes and decreased the doctors’ exposure to HIV/AIDS. As told by Dr. Kurt Bernischke, a Boston pathologist and author of Pathology of the Human Placenta (2) , this type of closure increased the chances of uterine rupture in a subsequent labored delivery by “five-fold.” The extra-harsh news in this study is that the doctors have not always documented the type of closure in patient files. Who knows who has actually had it done except the doctors?
Now Take a Look at Surgery
That was a lot to take in and, trust that it is only the microscopic tip of the iceberg. Studies covering VBAC births and the controversy inside hospitals and doctors’ offices surrounding the acceptance of this choice in delivery are numerous and confusing. Even the insurance companies are beginning to deny coverage for certain aspects of a VBAC delivery. Moms are being denied the right to have that freedom of choice or informed consent in medical care little by little.
Without getting too involved in the risks of Cesarean section surgery, at least consider the costs and the risks to the mothers and babies. Surgery is expensive, anesthesia is scary and also expensive, recovery is up to two days longer than a natural delivery, Mom may not be able to handle a baby right after surgery, the pain medications will go into the breast milk if she is feeding the child herself, bonding may be delayed because the nurses have to keep the child for Mom if she is unable to hold her…need there be more? Take a look at some information regarding the psychological burden on mom and baby after a surgical birth. Here is one for thought, “According to Newsweek, these unimaginable demons cause mothers to kill some 200 children in the US each year. PPD (post partum depression) can occur after the most normal of pregnancies but is more common and more severe after the added stress of a Cesarean or other operative delivery and when a baby is premature or must be in the intensive care nursery after the birth.” (2)
There is a ship load of information available and many support groups out there for the expecting mother who had a C-section and wishes to have her next child by labor. Not all doctors are supporting it but someone out there will help you find ones that do.
To ask more questions and to research further into this issue, here are just a few websites to use. Some of these include links for further information. And good luck with the journey!