May 22, 2010 02:48 AM
I am a mother of 3, expecting #4 in November. I have had three csections,
first two were breech, third was preeclampsia. I am very interested in
having a vbac this time around. I wanted one last time and had a midwife,
but with preeclampsia, I was admitted to the hospital and the admitting dr said if I refused a csection,
they'd refuse care and I'd have to leave, so I had my third section. Only recently I found out that
what the dr did was a violation of my human rights.
On to the question, I've looked at the risks on both sides, but can't find
anything that shows the risks for both csection4 and vbac3 which is my
particular case. Can you help with that information? I am really trying to
weigh the odds here. The local hospital and drs are not friendly at all to
a vbac of any sorts, but have said they'd prefer I'd vbac in a hospital as
opposed to at home. My husband and I don't find great comfort or
confidence in that, as it's so easy to have the situation manipulated to a csection when you have nonsupporting medical intervention.
I have found a dr, who's in another state, who is very friendly toward vbac's and vbac3 is "no big deal" to him. I'm meeting with him next month, but I want to be informed on both sides of this. I know family will be concerned about my health, especially if I choose a VBAC so I feel I need to prepare myself, and them with true statistics of what can happen with a 4th section, or vbac3.
May 29, 2010 02:17 AM
Here is what I can tell you from my researches for the VBAC vs. elective repeat c/sec chapter for the new edition of Obstetric Myths Vs. Research Realities. I'm going to summarize the points, but I have the research to back them.
- Mortality: Maternal mortality rates favor women planning VBAC over women planning elective repeat cesarean. The likelihood of maternal death with elective repeat c/sec (3 per 10,000) in a large U.S. study was in the same ballpark as the likelihood of the baby dying as a result of scar rupture (1 per 10,000). The same study showed a higher rate of non-scar related perinatal death (7 per 10,000) with planned VBAC and of hypoxic ischemic encephalopathy (3 per 10,000) (neurologic injury believed to be related to hypoxia), but rates are low and some cases might have been avoided by more judicious use of induction and augmentation in what may be a more vulnerable population.
- Morbidity with increasing numbers of cesarean surgeries: Every c/sec increases the likelihood of abnormal placental attachment--placenta previa (placenta overlays the cervix), placenta accreta (placenta invades the uterine muscle)--complications associated with strong potential for severe adverse outcomes in mother and baby. Accumulating cesarean surgeries is associated with a dose-dependent increased risk of severe adverse outcomes over and above risks associated with any individual cesarean or increasing parity. These include hysterectomy, severe hemorrhage, dense adhesions (internal scar tissue) that can cause chronic pain and make any future surgeries more difficult and dangerous, operative injury to organs or blood vessels, maternal need for ventilation, and ileus (paralyzed bowel). Babies are more likely to be born preterm, and both mothers and babies are more likely to be admitted to intensive care.
- Having multiple prior c/secs has little if any effect on the likelihood of scar rupture with planned VBAC.
- With a care provider who is truly supportive of VBAC, the odds of VBAC with multiple prior c/secs are 3 out of 4.
- Once a woman has a VBAC, she is likely to go on having uneventful VBACs in future pregnancies.
And, of course, you run the risks of any individual cesarean surgery. A PDF detailing these risks can be found on the CIMS website.
Because you are already at increased risk of placenta previa, accreta, or the two in combination, an ultrasound evaluation should be part of your decision-making process.
If you decide to pursue a VBAC, there may be other info among the VBAC threads on this Forum that could prove helpful, and if you haven't been to the International Cesarean Awareness Network website, I'd poke around there as well.
All Times America/New_York
Please note that this Forum is intended to help women make informed decisions about their care. The content is not a substitute for medical advice.