VBAC, or vaginal birth after C-section, has become controversial due to legal restrictions, hospital policies, and rising malpractice premiums. Cesarean deliveries account for approximately one million births annually in the US, with a rate of 28% in 2005. Obstetricians are divided on the VBAC debate, with some being cautious and others leaving the decision up to the mother. Women who want to attempt a VBAC have about a 60-80% chance of success, especially if they’re a good candidate for it. Over 300 American hospitals nationwide have banned VBACs.
A VBAC, or vaginal birth after C-section, is when a mother delivers her baby vaginally after previously delivering a baby via C-section or C-section. Up until the late 1970s, mothers could not hope to deliver a baby vaginally after undergoing a C-section, due to the limitations of medical knowledge at the time. The 1980s and 1990s saw an increase in VBACs due to increased medical research and knowledge, as well as an increase in mothers demanding more freedom of choice in childbirth. Now, due to legal restrictions, hospital policies, and rising malpractice premiums, VBAC rates have dropped dramatically.
Cesarean deliveries, which involve a horizontal incision below the “bikini line” and along muscle fibers to deliver, account for approximately one million births each year in the United States. In 1970, the C-section rate was about 5%, while in 2005, the rate was 28%.
Today, obstetricians are divided on the VBAC debate. Some are cautious and only deliver via C-section after a previous C-section. Whether they believe it is safer to give birth vaginally or by C-section, many of these doctors are bound by hospital policy, state regulations, or their own malpractice insurance. Other obstetricians leave the decision up to the mother, as long as she is a good candidate for a VBAC.
For those arguing against a VBAC, safety for the fetus and mother is their primary concern. They argue that risking a VBAC could cause uterine rupture, severe blood loss, lack of oxygen to the baby during delivery, infection, and in the worst case scenario, infertility or death of both the baby and the mother. While the risk of uterine rupture in a VBAC is less than 1%, it’s not a risk many doctors are willing to take. A failed VBAC may carry a higher risk of complications than a successful VBAC, and the birth still results in a C-section. Proponents of C-section argue that the convenience of delivery is another benefit; it is convenient, the mother avoids a long and painful labor and can choose her son’s birthday.
Women who want to attempt a VBAC have about a 60-80% chance of success, especially if they’re a good candidate for it. Recent medical research supports VBAC, if only to avoid potentially dangerous major abdominal surgery. Proponents of VBAC argue that cesareans have a higher rate of rehospitalization after birth, subsequent uterine rupture in subsequent births, and infertility. A 2005 study showed that 11% of all C-sections were unnecessary and 65% of second C-sections were unnecessary. Recently, Consumer Reports magazine named a C-section number three on its list of “12 surgeries you might be better off without.”
The debate is raging and it’s getting harder and harder for women to make the decision on their own. Over 300 American hospitals nationwide have banned VBACs. One hospital has even gone so far as to take a woman to court to force her to have a C-section after an ultrasound revealed a possible 13-pound (5.9 kg) baby who would be difficult to deliver vaginally. She was able to successfully deliver what turned out to be an 11-pound (4.99 kg) baby vaginally at another hospital.
If your doctor is open to a VBAC, you’ll need to meet certain criteria to try one. You may have only had a C-section with a low horizontal or transverse incision. Your pelvis should appear large enough to accommodate a baby passing by. You should not have had any other uterine surgery or a past uterine rupture. You also cannot have any other medical conditions that could make vaginal birth unsafe. As a precaution, a doctor and anesthetist should be available throughout the delivery in case an emergency C-section is needed.
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