Are VBAC’s Safe?
After my first birth ended in an emergency c-section, I spent a lot of time on the internet researching my options for my next birth. I have vivid memories of spending many middle of the night feedings with my newborn daughter combing through articles on the safety of VBAC’s. I didn’t have a great c-section experience and wanted to know what other options I would have going forward.
There is a lot of information out there regarding if VBAC’s are safe. So many statistics and opinions and it can be hard to understand the facts that should inform your decision. I wanted to put together a simple and evidence-based post to help present some of the information that led to my decision to try for and eventually have a successful VBAC.
What is a VBAC and why can it be controversial?
VBAC stands for Vaginal Birth After a Cesarean. Another term you might see used often in this discussion is TOLAC which stands for Trial of Labor After Cesarean. Basically, a TOLAC is the attempt or process leading up to a VBAC. A successful TOLAC leads to a vaginal birth.
In my experience, many woman hear the term “VBAC” and automatically feel like it’s a risky option that isn’t attainable for them. Many woman I know who have had c-sections genuinely had no idea a VBAC was even an option! This is particularly odd to me, considering that many very reputable and trustworthy voices in the OB world consider them to be a good option for many women who have had c-sections.
ACOG
The American College of Obstetrics and Gynecologists, or ACOG, is one of those voices. ACOG defines themselves this way- “For more than 60 years, ACOG has written guidelines that obstetrician–gynecologists (ob-gyns) and other medical professionals use when taking care of women. ACOG is a professional membership organization that represents more than 60,000 ob-gyns, medical students, and other health care professionals.”
When recommendations come out of ACOG, they come with tons of research, statistics and evidence behind them. This is a direct quote from the ACOG website regarding VBAC’s, “In addition to fulfilling a patient’s preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level.”
If you take the time to look at the ACOG website regarding VBAC’s, the language is overwhelmingly positive. And yet, so many doctors in the OB world are still extremely hesitant and generally negative when it comes to their patients attempting a TOLAC.
So where is the breakdown? There are probably too many answers to that question for this article, but it is clear that there is a breakdown between the leading voices in the world of obstetrics and the doctors that woman are depending on for care throughout their pregnancies and births.
VBAC risk vs Repeat Cesarean Risk
The biggest question that is on your mind if you are considering a VBAC is likely regarding how safe it is, both for you and for your baby. The reality is, despite all of the fear and controversy that surrounds VBAC’s, the statistics show that a VBAC and a repeat cesarean have a very similar risk.
VBAC risk
When discussing the greatest risk for VBAC patients, the conversation revolves around uterine rupture. A uterine rupture occurs when the scar on the uterus from a prior cesarean ruptures, or tears. This can be catastrophic for both mothers and babies. The good news is, the uterine rupture rate is statically very very low.
The risk of a rupture occurring during a TOLAC is about .47% or 5/1000 (https://www.thevbaclink.com/uterine-rupture/). And of that .47%, the vast majority of uterine ruptures that occur are treated without any long term effects on mothers and/or babies.
Elective Repeat Cesarean Risk
Repeat cesarean’s are often unquestioned by many women, which is interesting because repeat cesarean’s have their own set of risks that come with them. Aside from the regular risk of any major abdominal surgery, cesareans carry specific risks like:
-Placenta Accreta
-Dense adhesions
-Hemorrhage
-Breathing problems in the baby
A great source on all things VBAC is VBAC Facts. They have a great article about VBA2C’s here. They explain the risks of repeat cesareans like this, “In fact, the risk of certain pregnancy, delivery, and postpartum complications increase with each cesarean birth. These include risks of serious placental abnormalities like placenta accreta (placenta abnormally attaches to the uterine wall) and placenta previa (placenta attaches close to, or over, the cervical opening), hysterectomy, large blood transfusions, surgical injuries (bladder, bowel, and ureters), ICU admission, infection, post-operative ventilator, operative time, and hospital stays. (Silver, 2006) The risks of placenta accreta and hysterectomy in particular are significant: “women having their fourth or more cesarean delivery had a 9- to 30-fold increased risk”.
To summarize, there is risk associated with VBAC’s but it isn’t a significantly higher risk than comes with repeat cesarean’s and therefore should be an option that is more widely discussed and recommended to women who have had a cesarean. Is the risk substantial and worthy of being taken seriously? Absolutely. However, should women be pushed toward repeat cesareans, which come with their own set of substantial risk, without at least considering VBAC’s? I certainly don’t think so.
To TOLAC or not to TOLAC
Ultimately, the decision to TOLAC is a very personal decision that requires a lot of education on VBAC’s and lots of conversations with the birthing professionals in your life. My main desire from this article isn’t to convince anyone to have a VBAC but to encourage more open discussions on the true statistics which support VBAC’s as a good option for many many women, even though it seems that very few woman are being told that by medical professionals. In fact, only 20% of woman who have had a prior cesarean plan a vaginal birth and after 2 previous cesareans that number drops to 2.9% (VBAC Facts).
I didn’t cover even a portion of all the things that go into a decision like this and I highly encourage you to spend some time diving into the evidence behind VBAC’s. Read more about my personal VBA2C story here and check out the resource list below to dive into some of the sources that helped me gain so much understanding into the world of VBAC’s:
https://evidencebasedbirth.com/ebb-113-the-evidence-on-vbac/