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The VBAC/repeat C-section debate

Posted Jan 15 2009 7:52pm
I've been debating the VBAC/repeat c-section route for myself since I got pregnant, well, actually before I was even pregnant. At this time I plan on VBAC, but every once in awhile, I start to worry and think maybe a c/s would be ok. I have done extensive research on this topic and thought I'd post some of my findings to remind myself of the advantages of a vaginal birth. These figures are from 1 source, but all sources I found report about the same figures. Uterine rupture is what causes the concern for a woman wanting to labor after having a c-section. The scar tissue is weaker and the concern is that the uterus will come apart at that scar during labor. Depending on the severity of the rupture, you worry about the outcome of the baby and mother.

1. The chance of uterine rupture with 1 uterine scar is approx .6% with a .018% perimortality rate; 2 scars= 1.8% chance of uterine rupture. These risks are similar to any other unpredictable risk of labor and delivery.

2. One study found that of 17613 VBAC's attempted, only 5 had babies who died due to a uterine rupture.

3. Vaginal birth is safer than a surgical delivery. C-Section increases risk of hemorrage, adhesions, anesthetic complications, injury to fetus, etc.

4. These increase the chance of uterine rupture: induction, pregnancy/labor less than 24 months after a c-section, classic uterine incision, age above 30.

Of course each person's case is different. I am on the low risk end. I delivered my first baby vaginally with a relatively easy labor and very little pushing time, I am under 30, it's been 3 years since my c-section, my incision was the lower uterine transvere (bikini cut), and my MD will not induce labor for a VBAC. The hospital I will deliver at requires that anesthesia and the surgeon be present during the labor (sucky for them) so that surgery can be done very rapidly if a uterine rupture occurs. I work with very comptetant nurses and have full faith that they would recognize a uterine rupture if it were to occur. Now all I have to do is hope that the little bean will cooperate and be in the head down position when the time comes in about 19 weeks!
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