Bringing Back VBAC: Good for Women and Babies?

Lamaze International urges that most mothers with a previous cesarean section should be offered the opportunity to have a VBAC.

[USPRwire, Mon Mar 08 2010] Next week’s National Institutes of Health meeting on vaginal birth after cesarean (VBAC) will explore one of the biggest controversies in childbirth. Is VBAC a reasonably safe birthing option for women and their babies?

A growing number of women are counseled by their health care providers that VBAC is too risky – citing a fear of uterine rupture, a rare, but potentially dangerous complication – and told that a repeat cesarean carries little threat of harm. As a result, the VBAC rate in the United States has plummeted.

In the late 1980’s and mid-1990’s VBAC rates steadily increased, hitting a high of 28 percent in 1996. However, a decade later, fewer than 1 in 10 women delivered by VBAC (8.5 percent). Experts attribute the shift to several malpractice lawsuits, which influenced practice behaviors by obstetricians.

One of the key issues for the experts convening at the NIH next week is whether current VBAC practices are driven by research and data.

“There’s medical evidence that shows that most mothers with a previous cesarean section should be offered the opportunity to have a VBAC,” said Debra Bingham, president-elect of Lamaze. “Yes, there are risks with a VBAC, but there are also dangers to both mothers and infants associated with a repeat cesarean, and particularly multiple repeat cesareans. Once you have that first cesarean, your risks during any type of subsequent delivery go up. We should also work to reduce unnecessary cesarean sections.”

• A just-released study shows that the newborn death rate in low-risk women is lower for those born by VBAC than those born by repeat cesarean
• Two studies, one done in 2008 and another in 2006, show that women who undergo repeat VBACs suffer fewer complications than women who undergo repeat cesareans, and babies fare increasingly better with each subsequent VBAC delivery
• A study from February 2010 challenged the conventional wisdom that women with multiple prior cesareans should not be allowed to attempt VBAC, and showed that VBAC outcomes for mothers with three or more prior cesareans are as good as outcomes for women who only had one prior cesarean

Cumulatively, these and other studies demonstrate that while VBAC carries risk, for most women it is likely the healthier choice for herself and her baby. The potential for problems in both mother and baby decrease with every VBAC and increase with every cesarean.

“We shouldn’t overlook the importance of another key issue - patient autonomy,” said Sharon Dalrymple, president of Lamaze. “The reality is that both VBAC and repeat cesareans have pros and cons – no woman should be forced into one or the other. The principles of informed consent must apply to every person who walks into a hospital, including pregnant women and health care providers and institutions that usurp that right are ethically out of bounds.”

A major driver in shrinking VBAC rates is a community of reticent health care providers and hospitals that have instituted formal bans on VBAC. Many have cited liability concerns as the basis for their policies. A survey conducted in January 2009 by the patient-advocacy group, International Cesarean Awareness Network (ICAN), found that half the hospitals in the United States have a formal or informal VBAC ban.

“These institutions are telling women ‘agree to surgery or we won’t give you care.’ Being forced to agree to surgery should never be a condition for receiving care. This position is especially untenable when the research speaks so favorably to VBAC being an optimal choice for most women,” said Dalrymple. “We urge the NIH panel to weigh the evidence and balance it with the need for every health care provider and institution to respect the rights of patients to make decisions about their own care.”

Offering women the option for VBAC gives women access to the same benefits as any other vaginal birth would, including:
• lower risk of infection, surgical injury and severe or longer-lasting pain
• lower risk of breathing problems for the baby
• shorter recovery time
• more successful bonding and breastfeeding
• reduced risk of complications in future pregnancies, including abnormal placental attachments which frequently lead to emergency hysterectomies from excess bleeding

“The panel has a responsibility to correct the misinterpretation and misapplication of VBAC research rampant in obstetric care, and issue a strong statement that women without compelling reasons for a repeat cesarean section should be given the option to have a VBAC,” said Bingham. “This is a real chance to reverse another worrisome trend in maternity care.”

About Lamaze International
Lamaze International promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting practices. Knowing that pregnancy and childbirth can be demanding on a woman’s body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years. Lamaze education and practices are based on the best and most current medical evidence available. Working closely with their families, health care providers and Lamaze educators, millions of pregnant women have achieved their desired childbirth outcomes using Lamaze practices. The best way to learn about Lamaze’s steps to a safe and healthy birth is to take a class with a Lamaze certified instructor. To find classes in your area, or for more information visit www.lamaze.org.