Posted By on 16 Oct 2009 11:17 AM
I am trying to research the latest and more proficient data on infant mortality regarding VBAC. I have had 2 C-sections, both of which dehissed and I spent 8 and 12 weeks respectively with an open wound healing from the inside out. I know the recovery will be longer this time, but more than that, I have ALWAYS wanted to have a vaginal birth. My OB scared me with my 2nd saying the infant mortality rate is 40% with VBACs, much less the possibility of my own complications. The reason for having the C-section in the first place was a small birth canal that is from what I understand "presumed" and not "confirmed". Will you lead me to where I need to research so I can be prepared when I go in to talk to him? Thank you.
I tried to follow Maria Armstrong's link, but got an error message. (Maria: can you fix this? Or provide a link to the page in PubMed instead? Use the "single citation" matcher in the sidebar to get the specific URL.) I can, at any rate, point you to a big, U.S., multicenter study that found that the likelihood of scar rupture was similar with one prior c/sec as with two. Rates were 0.9% in VBAC labors after multiple prior c/secs compared with 0.7% per 1000 with one. A review of the VBAC research (Guise JM, McDonagh M, Hashima JN, et al. Vaginal birth after cesarean (VBAC) Report/Technology Assessment No. 71. Rockville, MD: Agency for Healthcare Research and Quality March 2003. Report No.: AHRQ Publication No. 03-E018.) found that 5% of scar ruptures result in neonatal death. To calculate the odds of losing a baby because of a VBAC labor after more than one pror c/sec, multiply 5% by 0.9%, and you get 0.05%. Not exactly 40%.
As for your own risks, they are much higher with an elective repeat cesarean, and the serious risks for you and any future babies climb with each cesarean. In fact, a different analysis of the same population from the study I cited found that your risk of dying as the result of the complications of elective cesarean surgery (0.03%) is in the same ballpark as the risk of losing a baby to scar rupture.
Finally, your likelihood of vaginal birth with a prior diagnosis of "baby didn't come out" based on five studies falls somewhere in the range of 64-72%. Many women go on to have bigger babies vaginally than the baby they supposedly couldn't deliver the first time.
I agree with Maria about losing this ob. Either this ob is incompetent or deliberately trying to mislead you. Either way, this is not someone whose judgment and expertise you can trust.
-- Henci
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