Wednesday, August 14, 2013

VBAC vs RCS risks

VBAC vs Repeat CS Risks as presented by iCAN

VBAC or Repeat Cesarean
What is safe? What are my options?
If you have had a cesarean delivery and are planning another birth you have to make a decision to have a Vaginal Birth after Cesarean (VBAC) or a Repeat Cesarean Section (RCS).  This can be a hard decision with all the misleading information out there on both topics.  Lets look at some of the facts.
VBAC (Vaginal Birth after Cesarean)
The biggest concern with VBAC among women is uterine rupture. Permitting labor to begin naturally with a low transverse scar ("bikini cut") VBAC after one previous cesarean carries a risk 0.4% of uterine rupture with an increase in an augmented or induced labor. (Landon, 2004)  Successful VBAC's have lower complication rates than planned RCS which have lower complications than a "failed" VBAC. (Landon, 2004)
VBAC is a safe and appropriate choice for most women with one prior cesarean and for some women with two prior cesareans according to ACOG, 2010.
"the chance that a VBAC candidate will require emergency surgery, is for all practical purposes, no higher than that of any other pregnant woman" and "the risk of VBAC is not substantially greater than the risk of any type of childbirth" (Bruce Flamm, MD, Birth after Cesarean)
VBAMC (Vaginal Birth after Multiple Cesareans)
Here is a link to a study done in 2006 by Landon, Risks of Uterine Rupture with a Trial of Labor in Women with Multiple and Single Prior Cesarean Delivery.
The study of 975 women with multiple previous cesareans found a rupture rate of 0.9%. They also showed VBA2C within two years of a previous cesarean delivery to have a 1.1% rupture rate. Not nearly as high as many doctors tell you. Those risks are still lower than those risks of a 3rd cesarean.
Landon concludes, Vaginal birth after multiple cesarean deliveries should remain an option for eligible women.
Overall trial-of-labor success rates were 73%Single prior cesarean delivery success rate of 74%Multiple prior cesarean deliveries success rate of 66%Two prior cesarean deliveries success rate of 67%Three prior cesarean deliveries success rate of 55%
When a cesarean is necessary it can be a life saving procedure for mother and baby.10 true reasons for a Cesarean
Cesarean Risks include placenta accreta, hysterectomy, blood transfusion, ICU admission, which increases with each surgery and uterine rupture. Whereas with successful VBAC uterine rupture and other labor related complications decrease significantly.
The risks associated with RCS increase with each cesarean performed.
Maternal death is very low with each option: 0.02% with VBAC and 0.04% with RCS. (Landon, 2004)

Make an informed choice about the risks of Repeat Cesareans vs. VBAC's
1st C-section Risk of hysterectomy: 0.65%Risk of blood transfusion: 4.05%Risk of placenta accreta: 0.24%
2nd C-section 1st VBAC Risk of major complications: 4.3% Chance of successful VBAC: 63.3% Risk of placenta accreta: 0.31% Risk of uterine rupture: 0.87% Risk of hysterectomy: 0.42% Risk of hysterectomy: 0.23% Risk of blood transfusion: 1.53% Risk of blood transfusion: 1.89% Risk of dense adhesions: 21.6%
3rd C-section 2nd VBAC Risk of major complications: 7.5% Chance of successful VBAC: 87.6% Risk of placenta accreta: 0.57% Risk of uterine rupture: 0.45% Risk of hysterectomy: 0.9% Risk of hysterectomy: 0.17% Risk of blood transfusion: 2.26% Risk of blood transfusion: 1.24% Risk of dense adhesion's: 32.2%
4th C-section 3rd VBAC Risk of major complications: 12.5% Chance of successful VBAC: 90.9% Risk of placenta accreta: 2.13% Risk of uterine rupture: 0.38% Risk of hysterectomy: 2.41% Risk of hysterectomy: 0.06% Risk of blood transfusion: 3.65% Risk of blood transfusion: 0.99% Risk of dense adhesion's: 42.2% NOTE: "Major complications" include one or more of the following: uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.
All VBAC stats for this chart are taken from the Mercer and Gilbert study, 2008 which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates with non augmented or induced labors.

According to the World Health Organization (WHO) Countries with some of the lowest perinatal mortality rates in the world have cesarean rates of less than 10%. There is no justification for any region to have a higher rate than 10-15%.
In all 50 states VBAC is legal and in some states it is legal for a midwife to attend an OOH (out-of-hospital) VBAC. However of the women interested in VBAC 57% are unable to find a supportive care provider or hospital.
With the new AGOC (2010) guidelines in place we hope to see VBAC's increase and have more women find supportive care providers!You CAN birth!!

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