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Tuesday, September 6, 2011

Vaginal Birth After Cesarean Section: the REAL risks

I haven't written on a Birthing topic for a while..... since having my own VBA3C almost 19 months ago, I've been more  focused on issues to do with raising babies (and children), than birth.  I continuously get asked about VBAC (Vaginal Birth After Cesarean section) birthing, so when I read this article I fired up the blog: This information is VITALLY important to making a fully Informed Choice about how to give birth to your child.

Birth Without Fear blog brought this to my attention (check out their amazing articles HERE).

The original information comes from a Medscape article published in May 2010, which can be read in it's entirety HERE.

For Generations, women and families have been told that "Once a Cesarean Section, always a Cesarean Section".  Even during the 90's, when VBAC births were starting to become more encouraged, mothers were told horror stories of their risks- both to themselves and to their babies.  The buzz word used has always been " Uterine Rupture", a term designed to scare the bejesus out of any woman.

From the Medscape article:
"Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity.... uterine rupture is defined as a full-thickness separation of the uterine wall and the overlying serosa. Uterine rupture is associated with (1) clinically significant uterine bleeding; (2) fetal distress; (3) expulsion or protrusion of the fetus, placenta, or both into the abdominal cavity; and (4) the need for prompt cesarean delivery and uterine repair or hysterectomy."
Just the word "uterine rupture' is enough to scare most people, enough so that hospitals and doctors,especially in the States, won't even allow a woman with a previous uterine scar to have a TOL (Trial of Labour).  But how common is it really?  Hospitals (and their insurance companies), and Doctors (and their insurance companies) have led women to believe that the risks are so high, that only an insane person would want to take the chance. So much so that VBACs are actually banned in many many areas of the States. In Canada trying to find a doctor- or midwife- to support your wish to have a TOL for a VBAC birth is very difficult, and even if you do find one, there is a good chance that they will throw so many "necessary" interventions into your labour that your chances of succeeding are slim.

Back in July 2010 I wrote an article about ACOG's new guidelines for VBAC birth:

ACOG states that VBAC is a safe and reasonable option for most women, including some women with multiple previous cesareans, twins and unknown uterine scars.  ACOG also states that respect for patient autonomy requires that even if an institution does not offer trial of labor after cesarean (TOLAC), a cesarean cannot be forced nor can care be denied if a woman declines a repeat cesarean during labor. 

WHY has ACOG changed it's tune so drastically?  Because the statistics show that the real risks of uterine rupture are actually VERY low!!!

The Medscape article goes on to say this:

Incidence and risk factors
Meta-analysis of pooled data from 20 studies in the peer-reviewed medical literature published from 1976-2009 indicated an overall incidence of pregnancy-related uterine rupture of 1 per 1,536 pregnancies (0.07%). When the studies were limited to a subset of 8 that provided data about the spontaneous rupture of unscarred uteri in developed countries, the rate was 1 per 8,434 pregnancies (0.012%).

 Yes, the Risk of Uterine Rupture is not 1%,  not even .1%, but .07%!!!!!!

Birth Without Fears article: Uterine Rupture: A Look At 20 Peer-Reviewed Publications Goes on to say this:
Risk FactorsCongenital uterine anomalies, multiparity, previous uterine myomectomy, the number and type of previous cesarean deliveries, fetal macrosomia, labor induction, uterine instrumentation, and uterine trauma all increase the risk of uterine rupture, whereas previous successful vaginal delivery and a prolonged interpregnancy interval after a previous cesarean delivery may confer relative protection. In contrast to the availability of models to predict the potential success of a TOL after a prior cesarean section, accurate models to predict the person-specific risk of uterine rupture for individuals are not available.

There are many factors taken into consideration in the .07% including uterine anomalies, myomectomy, number and type of cesarean births, induction and more. That’s right, it’s not even just about cesareans. In that .07%, it includes complications for anomalies, traumas from car accidents or falling and INDUCTIONS!

So for all of you out there struggling to get the birth that you want, desperately searching for a care provider to allow you the Right to birth normally and naturally, arm yourself with KNOWLEDGE!  Show the STUDIES to your doctor or midwife.  Show them that you are an educated human, not an automaton that blindly follows orders.  It's your body.  It's your birth.  

My final note is for my Canadian friends.  Remember this:  you have the RIGHT to birth as you wish.  No hospital or doctor can FORCE you to have a repeat cesarean section.  KNOW your Rights and stand up for yourself and your child.  

For more info about my VBA3C birth in Cambridge Memorial Hospital, please read my story HERE..... read it and educate yourself about the support you need and the mistakes I made that you do not want to repeat!!

(Side note; sorry about the white highlighter in the end of the article.... I can't figure out how to get rid of it, lol)