Successful VBAC after Two Caesareans
July 6, 2006
Studies clarify risks for expectant moms
generally safe after C-sections, OSU doctor says
Saturday, July 08, 2006 Misti Crane THE COLUMBUS DISPATCH
firstname.lastname@example.org Original Article at The Columbus Dispatch
Jen Weber gets to enjoy her day-old son, Charlie, in their room at the Ohio State University Medical Center. She opted against a Caesarean section because she wanted a shorter recovery time.
Charlie Weber entered the world the natural way on Thursday afternoon, but not without some doing.
His mom, Jen, delivered his brother, Isaac, and sister, Aurelia, by Caesarean section.
This time she wanted to try a vaginal birth, but her doctor resisted, pointing to risks, particularly the slim chance her uterus would rupture, a dangerous complication for both mother and baby.
Despite increasing evidence that most attempts are successful, and that the risk of uterine rupture is less than 1 percent, vaginal births after C-sections remain rare, particularly in women who have had multiple C-sections.
Mrs. Weber had researched the issue and read recent medical research that shows a high rate of successful vaginal births and a low risk of serious complications, including brain damage.
She is healthy and felt willing to take the chance, knowing a C-section was possible if problems cropped up.
After several unproductive efforts to change her obstetrician’s mind, she switched to a doctor who studies vaginal birth after C-sections, called VBACs for short. Mrs. Weber’s initial obstetrician couldn’t be reached for comment.
“It was really difficult to find a doctor who was willing to do it,” Mrs. Weber said yesterday from her room at Ohio State University Medical Center. Charlie slept in a bassinet by her side.
With the help of Dr. Mark Landon and a doula, Mrs. Weber and her husband, Chris, welcomed their third child after about six hours of hard labor. There were no complications.
Landon, Ohio State’s director of obstetrics, worked on a 2004 study published in the New England Journal of Medicine and another in this month’s edition of the medical journal Obstetrics and Gynecology that have helped clarify the success rates and risks of vaginal delivery.
In the first study, three in four women had successful vaginal deliveries and a uterine rupture risk of less than 1 percent.
The new research, which included four years of data from 19 medical centers, shows that the risk remains just as low in women who have had multiple C-sections.
“Women should be told in absolute terms the risks. They should not be given incomplete or biased information,” said Landon, who was the lead researcher on the study.
“There is little reason not to offer trial of labor enthusiastically to women.”
C-section carries its own risks, including hemorrhage and hysterectomy, Landon said out.
But many doctors won’t try VBACs, particularly in women who have had more than one C-section, based on a recommendation from the American College of Obstetricians and Gynecologists.
Also, a fear of lawsuits has fueled a downturn in vaginal birth attempts. Some malpractice insurers refuse to insure doctors who oversee VBACs and others charge higher premiums.
Many rural hospitals have stopped allowing them because they can’t guarantee a full surgical team will be available in the case of a complication.
The national C-section rate rose to its highest point, more than 29 percent, in 2004.
At the same time surgical births climbed, births after prior C-sections sunk, to about 9 percent in 2004. In Ohio, it was about 15 percent.
Each woman should be counseled on her options and risks and make a decision based on those, said Dr. Catherine Spong, chief of the pregnancy and perinatology branch of the National Institute of Child Health and Human Development.
“There is no global statement that can be made,” Spong said. “It’s very clear that it needs to be individualized.”
For instance, a vaginal delivery might be more attractive for a woman who had one C-section because of a baby who was positioned sideways and another because she had triplets. But a woman who has struggled with multiple attempts at vaginal delivery that ended in Csections might be more reluctant, Spong said.
Mrs. Weber wanted a shorter recovery so she can spend time with all three children before returning to work. After her prior deliveries, she struggled with pain and fatigue and wasn’t back to normal before her two-month maternity leave was over.
Furthermore, she felt that a natural birth allowed for a better bonding experience between mother and son.
“With the C-section, the first face that baby sees is the surgical team. That’s not necessarily a nurturing environment,” said the 33-year-old Columbus woman.