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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Nov 12
    2005

    Infant mortality in vbac studies

    Archived User
    If a baby dies in a vbac birth, not related to a uterine rupture, does that count as infant mortality due to vbac? For example, a baby dies in a vbac to shoulder dystocia--- to me that should not be attributed to the vbac, but as a regular birth problem. I am wondering what my "true risk" is from a vbac birth. There are risks in every birth, but how much does my risk go up in a vbac.
    Thank you so much Henci for your commitment to birth and helping families. By: MommyDOK
    Archived User
    Population studies of VBAC births do, indeed, include intrapartum (during labor) and neonatal deaths (deaths in the 1st week after birth) from all causes, not just those associated with scar rupture. A good example is the study of VBAC at birth centers, Lieberman et al. 2004. This was a study of 1453 women with prior cesareans who were eligible for birth center care at the onset of labor. Seven babies died for a mortality rate of 7/1453 = 4.8 per 1000. Of these deaths, only 2 were related to scar rupture. (There were, by the way, six cases of scar rupture, one of which was not diagnosed until after the birth and another--not one in which the baby died--was diagnosed when the woman arrived at the birth center.) The case history of the other five deaths were as follows:

    "fetal bradycardia [slow heart rate] on arrival at birth center; true knot in cord"

    "failure to progress; fetal bradycardia developed during transfer"

    "blood tinged amniotic fluid; likely marginal [placental] abruption" This woman was at the birth center less than 20 min before transfer. It is worth noting that prior c/sec increases the risk of abruption.

    "status post shoulder dystocia"

    "breech; prolapsed cord on arrival at birth center"

    The mortality rate related to scar rupture is 2/1453 or 1.4 per 1000, and the non-scar related rate is 5/1453 or 3.4/1000. One could speculate on which, if any of these deaths, might have been avoided had the woman arrived in labor at a hospital instead of a birth center.

    Also, as I noted, the death attributed to a probable placental abruption was from a cause associated with prior c/sec. This death, together with those following scar rupture, is a cautionary tale on why the use of c/sec should be minimized. If the first c/sec could have been avoided in these three cases, it is likely that those babies would be alive and well today.

    -- Henci By: Henci Goer
    Archived User

    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.

    Archived User

    What? Diss that doctor, you are not safe inhis hands.

    Here is the latest study after 2 cesareans

    http://www.bjog.org/details/journalArticle/403939/Vaginal_birth_after_two_caesarean_sections_VBAC2x2014a_systematic_review_with_me.html

     

    ICAN also has great info about VBAC

    http://ican-online.org/vbac/vaginal-birth-after-multiple-cesareans

    Hope this helps you in the right direction.

    maria.

    Henci Goer
    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

     

     

    Archived User

    Let's see if this works

    http://www.bjog.org/details/journal...th_me.html

     

    maria.

    Henci Goer

    Nope, that one didn't work for me either. Give PubMed a try.

    -- Henci


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