Risks of VBAC for Mom AND Baby - Mothering Forums
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#1 of 21 Old 01-19-2010, 06:38 PM - Thread Starter
 
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Okay so I have searched HUNDREDS of sites/blogs/message board postings etc. for information regarding VBAC. I have also just watched the Business of Being Born (Ricki Lake), and read "THE VBAC COMPANION".

After talking to my new doctor yesterday he said that a VBAC is definitly safer for the mom as opposed to a c-section (especially repeat c-section), but that the risk to the baby is greater. Agh...what to do? I know that you only have minutes to do a c/s if you have a uterine rupture to save the baby.

My question: Does anyone know the stat's on baby risks? I see ALL over the place the 1% stat on uterine rupture. But what about other stats. My doctor is AWESOME and very well known in the valley as well as at the hospital I am attempting my VBAC at. I should note that the hospital itself is pretty good with a 75% success rate for VBACS.

Thanks!
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#2 of 21 Old 01-19-2010, 07:00 PM
 
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There is a CDC study showing that healthy babies born to healthy moms by scheduled c/s are three times as likely to die as babies born vaginally.

I forget the actual stats, but I am sure someone will have them. Only a very, very small fraction of ruptures are catastrophic. And the window for good outcomes after rupture is usually more that just a few minutes, with many stories I had read - the mom is easily able to make it from home to the hospital, have a spinal and get the baby out. As long as the placenta is not on the rupture site, you have a bit longer (20-40 minutes is what I have read).

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#3 of 21 Old 01-19-2010, 09:33 PM
 
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I don't know the exact studies or stats off the top of my head but I know I've read many reasons why VBAC is healthier for both baby and mother. Have you searched over all the information on the ICAN website? I would start there and if you don't find what you're looking for, join the ICAN forums or email list and ask there. There are women on the list that have done extensive research on VBAC and have the studies to back up their research.

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#4 of 21 Old 01-19-2010, 09:39 PM
 
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I've found this site to be pretty thorough http://vbacfacts.com/vbac/

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#5 of 21 Old 01-19-2010, 11:18 PM - Thread Starter
 
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I don't know the exact studies or stats off the top of my head but I know I've read many reasons why VBAC is healthier for both baby and mother. Have you searched over all the information on the ICAN website? I would start there and if you don't find what you're looking for, join the ICAN forums or email list and ask there. There are women on the list that have done extensive research on VBAC and have the studies to back up their research.

I have looked on ICAN, and also chatted on the forums, however IMO, I have found that site and message boards to be a little slanted/biased in one direction. Almost like "VBAC or nothing". I'm okay with having a c/s if I need to. I am going to be thurough in my research and efforts, but I'm not going to be bummed if it is c/s.

Does anyone know of other sites that are not so slanted either way. I have also found some sites that are so anti-VBAC it's obnoxious.
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#6 of 21 Old 01-19-2010, 11:53 PM
 
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Researchers at the University of Colorado did a study that showed the risks to baby (and mom) were greater in a repeat, non-medically-indicated c-sec. Here's the link to the story:

http://www.uch.edu/about/news/2009/r...s-at-risk.aspx

If you have any access to the medical journals, the full study is worth reading. I read it this summer, and iirc, the risks of a failed VBAC were approximately equal to that of a non-medically-indicated repeat c-sec.

Obviously, there are risks if there is a rupture, but in a properly-equipped hospital, those risks are pretty small overall.

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#7 of 21 Old 01-20-2010, 12:16 AM
 
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You can email this guy, he's pretty fact-focused (he tends toward the OB/medicalized model of birth but is honest about that bias which i appreciate): http://academicobgyn.com/
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#8 of 21 Old 01-20-2010, 12:44 AM
 
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This article discussed a large study showing neonatal mortality to be 2.6%, increasing to 6% when rupture which occurred outside the hospital were included. So that would be 2.6% of 0.5-1%. Pretty low odds.

http://www.aafp.org/afp/2002/0901/p8...020901p823-b13

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#9 of 21 Old 01-20-2010, 12:45 AM - Thread Starter
 
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Originally Posted by Realrellim View Post
Researchers at the University of Colorado did a study that showed the risks to baby (and mom) were greater in a repeat, non-medically-indicated c-sec. Here's the link to the story:

http://www.uch.edu/about/news/2009/r...s-at-risk.aspx

If you have any access to the medical journals, the full study is worth reading. I read it this summer, and iirc, the risks of a failed VBAC were approximately equal to that of a non-medically-indicated repeat c-sec.

Obviously, there are risks if there is a rupture, but in a properly-equipped hospital, those risks are pretty small overall.
I just got done reading the article. I have to say that was pretty interesting. Where did you find the medical journal (online, library etc.)? Thanks!
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#10 of 21 Old 01-20-2010, 12:55 AM
 
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Mothers who have never had a c/sec can suffer a uterine rupture just as easily as a mother who has had a c/sec. The problem is that no one is anticipating a rupture in a woman who has not had surgery on her uterus, so that makes it very dangerous. The injudicious use of pitocin and other drugs can cause a uterus to rupture and/or hemorrhage.

Babies born by ercs can suffer from prematurity, respiratory distress syndrome, zero catecholimine levels and many other problems. Just because the nicu is down the hall is no reason to put a baby through this distress.
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#11 of 21 Old 01-20-2010, 10:41 AM
 
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Originally Posted by miriam View Post
Mothers who have never had a c/sec can suffer a uterine rupture just as easily as a mother who has had a c/sec.
No, the risk for mothers who have had a c/s is MUCH higher. Most estimates I've read are the UR occurs in at most 1 in 8000 unscarred uteri. The figure is closer to 1 in 100 or 200 for scarred uteri.

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#12 of 21 Old 01-20-2010, 12:04 PM
 
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Originally Posted by womenswisdom View Post
No, the risk for mothers who have had a c/s is MUCH higher. Most estimates I've read are the UR occurs in at most 1 in 8000 unscarred uteri. The figure is closer to 1 in 100 or 200 for scarred uteri.
I think there is a lot of conflicting info available on this. I've also read stats showing u/r is more common in nonscarred uteri because of the increased use of pit and cervical ripening agents. Now that those drugs are not being used so much on scarred uteri, the numbers are changing. I wish I knew where I read it...

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#13 of 21 Old 01-20-2010, 12:54 PM
 
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#14 of 21 Old 01-20-2010, 01:24 PM
 
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Isn't that 1% risk of rupture for ALL moms, not just those with a scarred uterus? And then something like 1% of ruptures are catastrophic? Which makes the risk for a catastrophic rupture extremely low. Most ruptures are partial or windows-which really don't pose a huge risk, unless its where the placenta is. In fact, some moms have their scar itself open partially (I can't think of what this is called suddenly) and many don't even know it happened until after they have the baby. In fact, some moms have this tear for months and never have any issues. I don't think thats considered a rupture though-I could be wrong though.

I honestly and truly believe that a VBAC is safer in most instances than a repeat cesarean. As long as its managed properly-ie, no induction meds-I can't see an elective repeat cesarean as being better for either mom or baby. If I felt VBAC was unsafe, I wouldn't be having my baby at home.

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#15 of 21 Old 01-20-2010, 03:08 PM
 
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The risk of UR is about 1 in 500 (.5%) in labors where no artificial induction or progression medications are used (i.e. no prostaglandins).

The risk of UR in non-scarred uteri is primarily for women carrying multiples or women with GD and a very large baby, but it does occasionally happen in women with no other risk factors. It generally is more catastrophic than UR in a VBAC case, b/c VBACs are almost always closely monitored to look for UR.

As far as websites with nonbiased info - I think www.childbirthconnections.com does a nice job of outlining the pros and cons of VBAC vs RCS for both mom and baby, they give you a bottom line and fAqs for each and it's well laid out to be easy to read. According to their info (which I do not believe includes the U of C study cited above), VBAC is pretty much always safer for mom, and it is slightly riskier for baby. However, if you plan on having additional children after this one, it is definitely safer for future pregnancies to plan a VBAC with this one, as the more scars you have on your uterus, the higher risk to the baby. So if you look at the long view, VBAC is the way to go.

I also think of it this way, and it may seem cold to some - but right now my primary responsibility is to the daughter I'm already raising. The child I'm carrying is very important to me, but if I have to choose between the agonizing grief of losing a baby (my first was stillborn, so I know what I'm choosing), vs. having my daughter suffer the loss of her mother - I will take the loss of the baby and spare my daughter that pain.

ETA: full text of the U of C article available here: If the link doesn't work, google 'obstetrics and gynecology' and look for the June 2009 issue, this article is available for free through the journal's main site.
http://journals.lww.com/greenjournal...elivery.7.aspx
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#16 of 21 Old 01-20-2010, 03:17 PM - Thread Starter
 
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The risk of UR is about 1 in 500 (.5%) in labors where no artificial induction or progression medications are used (i.e. no prostaglandins).

The risk of UR in non-scarred uteri is primarily for women carrying multiples or women with GD and a very large baby, but it does occasionally happen in women with no other risk factors. It generally is more catastrophic than UR in a VBAC case, b/c VBACs are almost always closely monitored to look for UR.

As far as websites with nonbiased info - I think www.childbirthconnections.com does a nice job of outlining the pros and cons of VBAC vs RCS for both mom and baby, they give you a bottom line and fAqs for each and it's well laid out to be easy to read. According to their info (which I do not believe includes the U of C study cited above), VBAC is pretty much always safer for mom, and it is slightly riskier for baby. However, if you plan on having additional children after this one, it is definitely safer for future pregnancies to plan a VBAC with this one, as the more scars you have on your uterus, the higher risk to the baby. So if you look at the long view, VBAC is the way to go.

I also think of it this way, and it may seem cold to some - but right now my primary responsibility is to the daughter I'm already raising. The child I'm carrying is very important to me, but if I have to choose between the agonizing grief of losing a baby (my first was stillborn, so I know what I'm choosing), vs. having my daughter suffer the loss of her mother - I will take the loss of the baby and spare my daughter that pain.

ETA: full text of the U of C article available here: If the link doesn't work, google 'obstetrics and gynecology' and look for the June 2009 issue, this article is available for free through the journal's main site.
http://journals.lww.com/greenjournal...elivery.7.aspx
Thanks so much for the stats and sites/resources. Also, IMO you are definitly not cold at all! I feel the EXACT same way. It would be terrible and hard to lose this baby or have her born with some problems because of VBAC, however...I have a 2-year-old that is my first priority. I am his mother. I need to be here for him. I also need to be here for my husband. I don't want to leave my husband alone, or my son to be raised by anyone other than ME!
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#17 of 21 Old 01-20-2010, 04:17 PM
 
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The 2004 Landon study in the NEJM (12/2004) is a very good source for UR information. It included nearly 18,000 that had a TOL (trial of labor which may or may not lead to a successful VBAC). The overall rate of UR was 0.7% which translates into 124 uterine ruptures in that group of nearly 18,000. Only 2 of the babies died following a uterine rupture. Keep in mind, the group included women having a TOL after 1, 2, 3 and 4 c-sections. It also included women who classical, invert T and J incision as well as the low tranverse incision (which is most common and considered the safest for a TOL). About 25% of the women in the TOL group had their labors induced (with prostoglandins or pitocin) and/or augmented with pitocin which also increases risk of uterine rupture. About 25% of the women in the TOL group were less than 2 years from their previous c-section. Clearly, there were many other potential risk factors that could come into play here with the risk of UR.

According to this study :

The absolute risk of neontal death is 0.08% with a TOL vs 0.05% in an ERCS; stated otherwise, the risk of neonatal death is 1 in 1250 babies with a TOL vs 1 in 2000 with an ERCS .

The absolute risk of the mother’s death was 0.04% with an ERCS cs 0.02% with a TOL; stated otherwise, 1 in 2500 mothers will die due to an ERCS vs 1 in 5000 mothers will die with a TOL)


This study also separated out the number of women and the number of UR based on incision type:
- Low transverse incision (n=14,483): 105 ruptures (0.7%)
- Low vertical incision (n=102): 2 ruptures (2.0%)
- Unknown type of incision (n=3206): 15 ruptures (0.5%)
- Classical, inverted T or J incision (n=105): 2 ruptures (1.9%)
- Unclassified (n=2)

It also separated out the number of women based on rates/types of induction:
- Spontaneous labor (n=6682): 24 ruptures (0.4%)
- Augmented labor (n=6009): 52 ruptures (0.9%)
- Induced labor (n=4708): 48 ruptures (1.0%)
- With any prostaglandins, with or without oxytocin (n=926): 13 ruptures (1.4%)
- With prostaglandins alone (n=227): 0 ruptures
- With no prostaglandins (n=1691): 15 ruptures (0.9%)
- With oxytocin alone (n=1864): 20 ruptures (1.1%)
- Not classified (n=496): 0 ruptures

A Breakdown of the number of previous cesareans (obtained from a subsequent study by Landon in Obstetrics and Gynecology 7/2006) (the women who had more than 1 c-section were grouped together and had a UR risk of 0.9% while the women who had 1 VBAC had a risk of 0.7%):
• 16,915 (94.5%) had 1 prior cesarean
• 871 (4.9%) had 2 cesareans
• 84 (0.5) had 3 cesareans
• 20 (0.1%) with 4 cesareans
8 women had an unknown prior # of c-sections



Risks of choosing a a TOL (trial of labor) vs an ERCS (elective repeat c-section):

•More likely to suffer a uterine rupture – the rupture rate in the TOL group was 0.7%; there were no ruptures in the ERCS group, however, women who presented in early labor and did not have a documented intention to labor were excluded so it is possible that women went into labor before their scheduled c-section and ruptured but were excluded from this study’s data
•1.4 times more like to have a uterine dehisence (typically a benign, thin area in the uterus)
•1.7 times more likely to need a tranfusion
•1.6 times more likely to develop endometriosis
•1.3 times more like to have another adverse event such as (broad ligament hematoma, cystotomy, bowel injury, ureteral injury)
•1.6 times more likely for the baby to die (doesn't sound like that big of a difference right? Remember that babies only die in about 2-10% of uterine ruptures according to many studies AND babies do die after c-sections.

Risks of choosing an ERCS over a TOL:
•1.5 times more likely to need a hysterectomy
•2.5 times more likely to have a thromboembolic disease (deep venous thrombosis or pulmonary embolism)
•2 times more likely for mother to die

Risks of a successful VBAC delivery (remember that TOL can end in repeat c-sections) vs an ERCS:
• 1.2 times more likel to need a transfusion

Risks of an ERCS vs a succcessful VBAC:
•3 times more likely for mother to need a hysterectomy
•5 times more likely to have a thromboembolic disease (deep venous thrombosis or pulmonary embolism)
•1.5 times more likely to develop endometriosis
•4 times more likely for mother to die


2 things this study does not address regarding newborns is the incidence of respiratory distress in babies born by elective repeat cesarean which can be quite serious. It also does not address the number of babies that have brain damage as a result of a UR. I want to say the chance of brain damage is about 10-15% when you have a UR but I'd have to double check that. Obviously, UR is very rare but it does happen. When it does happen, UR rarely results in fetal death or brain damage though that too can happen. Babies are usually okay after UR. As far as the mother goes, it doesn't address the decrease in hospitals stay, post partum surgical infection, etc.

You only have minutes to do a c-s in the case of a catastrophic rupture. Most ruptures start small so there is time to do a c-section. See the first study in this link.

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#18 of 21 Old 01-20-2010, 05:39 PM
 
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I would also point you towards information compiled by the Childbirth Connection. Specifically, see:
http://www.childbirthconnection.org/...e.asp?ck=10210

[From their "about us" link on the website] The Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.

I just reread this page and it's really, really good. Best of luck with your decision.

Mom to James (ribboncesarean.gif 5/2006), Claire (vbac.gif 6/2008), furry kitties Calvin and Bob, and wife to Dennis. 

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#19 of 21 Old 01-20-2010, 09:58 PM
 
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I too lost my firstborn, and had an emergent cesarean in the process. I just gave birth last week via VBAC, 15 months after the section. My doc (who is AWESOME) checked the scar afterward manually and found no uterine dehision whatsoever. I definitely felt at the time of the birth (as I was laboring) that VBAC was safer, and looking back now I am absolutely overjoyed and on a high!

It's anecdotal, yes, but I am glad it turned out the way it did because baby and I are both supremely healthy, she is nursing SO well, is 3oz above her birth weight just 7 days after birth, is quiet, calm, contented and I am healing amazingly quickly compared to the section.

So I would say go for it. I will be again, next baby - I really felt safe during my VBAC, and the whole experience was life altering and very healing indeed.

*HUGE hugs* XxXxX

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#20 of 21 Old 01-22-2010, 10:30 PM
 
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I just got done reading the article. I have to say that was pretty interesting. Where did you find the medical journal (online, library etc.)? Thanks!
We found it online through a local university (in fact, through the university that did the study). DH teaches at that university though, so it was easy to access because he has the necessary passwords and such. A good bet might be to go to the physical local of a local college library and see if they have access to medical journals. If so, you should be able to access the journals there.

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#21 of 21 Old 01-23-2010, 02:07 AM
 
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I don't have the stats, and they've already been broken down for you. I can tell you, as someone who did lose my child in a VBA3C attempt, that I totally believe in VBAC over ERCS, in most cases.

I remember the conclusion I reached, after Aaron's death, even though I don't remember all the numbers I waded through to get there. That conclusion was that, compared to RCS, VBACs are:

1) Safer for the mom.
2) Slightly more likely to result in a serious bad outcome (eg. death, brain damage due to hypoxia) for the baby.
3) Much less likely to result in a less-serious bad outcome (breathing issues, NICU stay, etc.) for the baby.

VBAC is safe for most moms and most babies. Neither option is safe for everyone. Someone told me I must not believe VBAC is safe, anymore, because my baby died. Not true. I happened to be one of the women who got stuck on the bad end of the stats. Someone has to be. (Besides...I'm not going to get into my long, ugly "birth" story, but there's every possibility that my son would have lived if I were able to trust any OB/GYN. I'm not.)

FWIW, I didn't rupture. The other two women I know irl who have had stillbirths have never had a cesarean. So...my story may not even be relevant. But, I also know that I'll never forget how terrifying it was when I had dd1 (my second child, and second cesarean) and she would just stop breathing...or how angry I was when the nurse we asked about it replied, "oh - that kind of problem is very common for c-section babies". I never wanted the section in the first place, but I let myself be bullied. As I lay awake at nights, listening for her breathing, and freaking out every time it stopped, I really, really wished I hadn't. Nobody else cares, or even remembers, now - she's 6.5, and healthy as can be...but I'll never forget how terrified I was...terrified that after so many years of ttc, I was going to lose my child to my doctor's idea of "safe".

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Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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