Never thought I would have to PROVE this

I never thought I would actually have to sit down and take the time to prove how much safer VBAC is for healthy, low risk women that elective repeat cesareans.
But in light of a discussion I viewed today, I felt the need to break it down big bird barney style (in the words of my husband of course).

Without a compelling reason for surgery, VBAC in most cases is safer not only for mom, but also for the baby. While there is a risk of uterine rupture, for women with low, transverse uterine scars, the risk is 0.6% meaning less than 1 full percent. But in many cases, what we fail to take into the account is the risk for uterine rupture during any time of any subsequent pregnancy after having a cesarean. But most providers fail to tell you this, especially if they are an Obstetrician who would rather you schedule your birth. But no one is going to tell you that you are more likely to be hit by a car or struck by lightening than to suffer a uterine rupture which is the biggest fear of VBAC.

The scar is more likely to give way during a VBAC labor than in a repeat c-section; for most women (exceptions noted below), the added risk of the scar giving way is about 27 in every 10,000 VBAC labors. In other words, nearly 400 women would need to experience the risks involved with repeat c-section to prevent one uterine rupture during a VBAC labor.
In turn the risk of a uterine rupture resulting in a dead baby is even more slim.
While the scar giving way poses a threat to the baby, the added risk that the baby will die from a problem with the scar during a VBAC labor, compared with women planning repeat c-sections, is about 1.4 in every 10,000 VBAC labors. In other words, over 7100 women would need to experience the risks involved with repeat c-sections to prevent the death of 1 baby due to uterine rupture.
The chance that a uterine rupture could in turn cause a hysterectomy is…
If the scar gives way, some women have a hysterectomy (removal of the uterus). The added risk of needing a hysterectomy from this cause is about 3.4 in every 10,000 VBAC labors, when compared with women planning repeat c-sections. However, considering risk for hysterectomy from all causes, women who plan a VBAC are not more likely to experience an unplanned hysterectomy than women planning repeat c-section.

Now that we have covered those highly touted concerns about VBAC, I will move on to the prime example I always use as safety of VBAC.

Michelle Duggar. Now, if you are unaware of who Michelle Duggar is I will give you the “run down” on her birth history. Michelle is currently pregnant with her 19th child. Her previous 18 children have included 3 cesareans, 16 vaginal births, and 13 VBAC’s. On the Duggar’s website, they praise ICAN for being helpful on gaining knowledge of VBAC.
Michelle’s First Cesarean section was with her second pregnancy, which was twins Jana and John David. She went on to have many VBAC’s during that time, then had a second cesarean section with baby number 15, Jackson, and lastly with baby # 18 Jordyn for a transverse position when Michelle went into labor.
Now, that is a whole lot of VBAC’s not to mention many of them were before the “2 year” preferable waiting period in between pregnancies. While all women may not be Michelle Duggar, or even heal the way she does, if she does not show the safety of VBAC, I am not sure what ever will.

I move on though…
Then we examine the risk of repeat cesareans, and the increased risk for hemorrhage, hysterectomy, blood loss, infection, and also, the increased risk for uterine rupture in subsequent pregnancies.
Cesareans increase physically problems in mothers…
Compared with vaginal birth, cesarean section increases a woman’s risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction (due to scarring and adhesions from the surgery), to much more common problems such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.
Emotional well being….
A woman who has a c-section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth. Which is something I can personally attest to because I have been there, and done that. It is no joke.
Mothers who have cesarean sections also have increased hospital stays, chances for re-hospitalization, and increased postpartum issues than women who have an uncomplicated vaginal birth.
But the risks do not stop at the surgery itself, it also poses risks to future pregnancies, and outcomes of reproductive health in future pregnancies.

Lets look at the numbers… After A Cesarean…

1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion’s : 21.6% (1 in 5)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion’s : 32.2% (1 in 3)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in
Risk of Dense Adhesion’s : 42.2% (2 in 5)

When you look at these numbers they are not things you really want to mess around with right? So lets look at the numbers for VBAC’s.

1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)

2nd VBAC
Chance of Successful VBAC : 87.6% (9 in 10)
Risk of Uterine Rupture : 0.45% (1 in 222)
Risk of Hysterectomy : 0.17% (1 in 588)
Risk of Blood Transfusion : 1.24% (1 in 81)

3rd VBAC
Chance of Successful VBAC : 90.9% (9 in 10)
Risk of Uterine Rupture : 0.38% (1 in 263)
Risk of Hysterectomy : 0.06% (1 in 1667)
Risk of Blood Transfusion : 0.99% (1 in 101)

Now aren’t those a big difference in these numbers? It is not because VBAC is not safe, it is because Doctors are not practicing evidence based medicine anymore. Women are not being given informed and valid information on VBAC and I know this for a fact because when I post numbers like this on forum’s su
ch as Cafemom, women gasp and comment about how they never knew this, or their Doctor told them going into labor would give them a 25% chance of killing their baby or some other kind of dramatic number.
But when discussing the risks of elective repeat cesareans, they are not giving the evidence based statistics from above.
Now mind you, all the numbers above were taken from a study published in Obstetrics & Gynecology in 2008. Not something I just came up with as I was going along.

Being educated can help save you a whole world of health problems in the future.

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