VBAC is an incredibly political topic in the birth world. Doctors in the United States are telling women who have previously had ceasarean section births that baby number two will have to be born the same way. The driving factor in this situation is medical malpractice insurance companies, who are faced with a growing number of lawsuits from people claiming that an emergency ceasarean was not available quickly enough.
One of the effects of the rise in malpractice suits, is that these insurance companies are targeting a procedure that research shows is reasonable and safe. Many insurance companies are instituting strict standards of procedure for planned VBAC births, which can cost hospitals thousands more dollars to provide. Many companies are excluding coverage altogether for doctors to allow women with a history of C-Section to attempt a Trial of Labor (TOL). If the doctors and hospital have no insurance coverage, they will not allow the procedure.
What are the risks of a ceasarean section?
Risks of this major abdominal surgery include hemorrhage, bowel obstruction, pain, infection, and tissue scarring and adhesions. Bonding and nursing are challenged, and babies are more likely to be cut, born early, have breathing problems or weigh less.
What are the risks of VBAC?
Research shows that less than 1% of VBAC births result in uterine rupture (1.6 per thousand.) These studies have included women whose labors were induced. Pitocin and cytotec, labor induction and augmentation drugs, create artificially strong contractions, so it is likely that a study done with women experiencing spontaneous labor would have even lower chances of uterine rupture occuring. Cytotec is not used any longer in cases of previous ceasarean, and pitocin is monitered closely to keep the dose under control. The risks of the scar giving way were also greater when incisions were made vertically and higher, but the way the incision is made now, low and vertical, has much better results.
Vaginal birth itself has a greater risk of continuing perineal pain or incontinence, and a greater risk of baby suffering nerve damage in the shoulder area.
This is a topic that women need to continue doing their research about, as doctors may just tell them that a repeat ceasarean is the best option. Ceasarean section can be a life saving operation, if necessary, but the c-section rate in America is almost 30%. Many healthy women are facing unnecessary risks from this major abdominal surgery. 90% of women who have had previous ceasareans are having repeat surgeries. It is clear that ceasarean section has complications and risks, and the research leans toward those risks outweighing the risk of VBAC.
more online resources:
http://childbirthconnection.org/article.asp?ck=10166#systematic
VBAC research statistics
http://pregnancychildbirth.suite101.com/article.cfm/vbac_controversy
risks of c-section
http://www.mayoclinic.com/health/vbac/VB99999/PAGE=VB00009
The Mayo Clinic reports that VBAC is safer
http://findarticles.com/p/articles/mi_m0CYD/is_3_40/ai_n11832004/
insurance companies set standards for VBAC procedures
http://pregnancy.about.com/od/vbac/a/deniedvbac.htm
What to do if you are denied access to medical care for a VBAC
