New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology , has found that women with 3 previous Caesarean Sections have similar outcome rates of success as women with only one previous Caesarean section in a study of 25000 women attempting a vaginal birth after a Ceasarean section. The study shows that not only did the women with 3 previous C/Section uterine scars have a very similar rates of success in having a VBAC birth, but that the rates of morbidity were also very similar between the women that had a VBA3C and those that chose to be delivered by elective repeat caesarean.
This is the first study that has analysed this large a group of women- over 25000 women with at least one previous Ceasarea section over a period of 3 years. I am currently waiting to receive the full abstract of the study and will post it here for those women, like my self, that are searching for the hard proof to back up their decisions to have a VBAC Birth.
Not only am I going to be giving a copy of this article to my midwives this morning, but I think I will attach a copy to my birth plan that I will be handing out at the hospital to the Obstetrical staff.
....Pardon me while I go dance a gig in my kitchen again.
Do We Need To Revisit VBAC Guidelines For Women With Three Or More Prior Caesareans?
Main Category: Pregnancy / Obstetrics
Article Date: 04 Feb 2010 - 1:00 PST
New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology has found that women with three or more prior caesareans who attempt vaginal birth have similar rates of success and risk for maternal morbidity as those with one prior caesarean, and similar overall morbidity (adding vaginal births and emergency caesareans together) as those delivered by elective repeat caesarean.
Planned vaginal birth after caesarean (VBAC) refers to any woman who has experienced a prior caesarean birth who intends to try for a vaginal birth rather than to deliver by elective repeat caesarean. Although relatively low complication rates, including uterine rupture, have been demonstrated among women with two prior low-transverse caesareans who attempt vaginal birth, there are very limited data available on outcomes among women with more than two prior caesareans. Neither the American College of Obstetricians and Gynaecologists (ACOG) nor the Royal College of Obstetricians and Gynaecologists (RCOG) currently recommend planned VBAC attempt in women with three or more prior caesarean deliveries1.
In this study, the researchers sought to estimate the rate of success and risk of maternal morbidity in women with three or more prior caesareans who attempt VBAC. The study reviewed multi-centre data from 17 tertiary and community delivery centres in the Northeastern United States from 1996 to 2000. A total of 25,005 women who had a least one prior caesarean delivery were included.
The findings indicate that women with three or more prior caesarean deliveries did not experience a difference in morbidity based on whether they attempted VBAC or elected for a repeat caesarean. The 89 women with three or more prior caesareans who attempted VBAC were as likely to be successful as women with one or two prior caesareans, 79.8% compared to 75.5% and 74.6% respectively. In addition, none of them experienced significant maternal morbidity such as uterine rupture, uterine artery laceration, and bladder or bowel injury.
The authors suggest that, given the findings, precluding VBAC for all women with three or more prior caesareans may not be evidence based. Although there is a measurable maternal morbidity associated with delivery for a woman with a history of three or more prior caesareans, it does not differ significantly by mode of delivery. Risks associated with multiple caesareans are several, including surgical morbidity and abnormal placentation in future pregnancies.
Lead author, Dr. Alison Cahill, from the Department of Obstetrics and Gynaecology at Washington University in St. Louis School of Medicine, said "These data suggest that women with three or more prior caesareans who attempt VBAC have similar rates of success and risk for maternal morbidity as those with one or two prior caesareans, and along with other publications, suggest that perhaps it is time to revisit the current recommendations for VBAC attempts for women with more than one prior caesarean".
"Many have proposed a 'conservative' approach to VBAC attempts, which we agree is prudent. But our evidence does not suggest that a conservative approach, which we interpret as one that aims to reduce morbidity - and specifically the risk of uterine rupture - is necessarily achieved by allowing VBAC attempts only in women with one prior caesarean. Given appropriate patient selection, VBAC following two or even three previous caesareans in certain cases may be reasonably safe."
Prof. Philip Steer, BJOG editor-in-chief, said "Although confidence in the findings of the study is limited by the relatively small sample size of women who have had three previous caesareans, these findings provide additional information for women, and contribute to the available evidence on VBAC success and safety in women with more than one prior caesarean.
"As childbirth does not always 'follow the plan', the results may also serve as a useful reference for clinicians when a women with three or more prior caesareans presents in spontaneous labour."
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal and include the website: http://www.bjog.org as a hidden link online.
"Vaginal birth after caesarean for women with three or more prior caesareans: assessing safety and success."
Cahill A. Tuuli M, Odibo A, Stamilio D, Macones G.
BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02498.x.
1. American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin #54: Vaginal birth after previous cesarean. Obstet Gynecol 2004;104:203-12; Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No.45, Birth After Previous Caesarean Birth (February 2007) available online here.
American College of Obstetricians and Gynecologists
HERE to go directly to the original Article
HERE to read the original abstract of the study
FURTHER information about VBA2/3/4C
AND MORE info...