Doctor insights on:
Why Is A Vbac So Controversial
Uterine Rupture: Vaginal delivery after C-section is controversial because of a complication that occurs in approximately 1/200 cases where the scar from the previous surgery opens up. This is called a uterine rupture. Strict guidelines in hospitals as well as the medical legal climate have made it difficult for some doctors to offer this service. ...Read more
Vbac stands for vaginal birth after cesarean. Because the uterine muscle has a scar from the prior surgery, and scar tissue isn't as strong as unscarred tissue, there are some additional risks to attempting a vaginal delivery after a cesarean. <1% of patients attempting vbac will have a complication ...Read more
Uterine Rupture: The most common complications are a failed vbac & need for vaginal bypass (c-section). The most serious are uterine dehiscence (separation of the uterine scar) or rupture. This can lead to catastrophic results with hemorrhage, emergency surgery, hysterectomy, and fetal loss. Major point - please vbac in a hospital where your OB can keep you safe and have access to immediate surgery if needed. ...Read more
Uterine Rupture: The most worrisome risk of a VBAC is rupture of the uterine scar. If you have a low-transverse uterine scar, the risk of this is low, around 1% (1 in 100). However if it happens to you, it can be very dangerous for your baby. Another risk is problems in labor that lead to a c/section anyway. This happens to 20%-40% of VBACs. Infections are higher in women who had a c/section after labor. ...Read more
Lot of variables: To have a higher likelihood of a vbac, you should have a cervix that's dilated, better if you are already in labor. If you had a previous csection for failure to progress in labor, you are less likely to deliver vaginally then someone who had a cs for breech presentation. ...Read more
VBAC vs RCS: A VBAC is a possible way to avoid another c/section. It isn't always successful and carries a small risk of catastrophic uterine rupture. VBACs are less successful in women who haven't had a prior vaginal birth, especially if the c/section was done for "failure to progress, " or "arrest of dilation". A repeat c/section is a way to avoid the risks uterine rupture and unsuccessful labor. ...Read more
Risky proposition.: Vbac (vaginal birth after cesarean section) sounds like a worthwhile goal, but given the risks associated with it (uterine rupture, maternal-fetal hemorrhage/death) only consider it with one prior kerr c-section, normal weight for height, prompt access to a large maternity hospital, and desire for at least 1 more pregnancy after this current one. Fetal death/injury is ~10 times increased in tolac. ...Read more
The answer is very complicated
if the patient id ideal candidate the risk is less than 1% for uterine rupture
i mean by that:
1- history of only one low transverse c-section.
2- natural labor occurs.
3- more than 14 months since last c-section
the reason of the c-section matters too
full consult with doctor is important and each case should be indivisualized ...Read more
VBAC non starter: VBAC, or vaginal birth after C/section, can be successful if the right patient is very closely monitored in labor to diagnose an avoid cataclysmic rupture of the uterus. However, due to medico-legal issues or time constraints, many MD's are justifiably unwilling to take on that particular challenge in practice. If you find a MD to consider that procedure you must be willing to accept the risks. ...Read more
Physiologically, yes: Physiologically, oxytocin Rx can induce labor in pregnant patients who are near term in their pregnancies. However, VBAC is very controversial as to whether a OB MD should do so due to the chance of catastrophic uterine rupture from a previous C/section scar. Many OB MD's will not induce a patient under those conditions. ...Read more
VBAC: Vbac stands for vaginal birth after cesarean. Because the uterine muscle has a scar from the prior surgery, and scar tissue isn't as strong as unscarred tissue, there are some additional risks to attempting a vaginal delivery after a cesarean. <1% of patients attempting vbac will have a complication known as uterine rupture. ...Read more
Uterine rupture.: Catastrophic uterine rupture is the most serious complication of attempted vbac (vaginal birth after cesarean section): it can prove lethal for the fetus, the mother or both! If you do not want anymore children, this is too great a risk to take - you may be better off with a prelabor scheduled repeat c-section and bilateral tubal ligation. Talk to your obstetrician! ...Read more
18 year old: I would like to try to redirect your thought process a little. At 18 with two small children maybe a better approach to life would be to start birth control and focus on your future as well as raising your two very small children. Being a teen mother is very hard and going to get harder as your kids grow up. Focus on them instead at the moment instead of the route of delivery of your next. ...Read more
Maybe...: Technically, this can be done if you can find a doctor willing to help you. Its a complicated decision, however, that depends on many factors such as the reasons why you had the first 2 c/sections and if you had a natural birth prior to the first C/section. There are many situations where a VBAC in this situation wouldn't be recommended. Best wishes! ...Read more
Much, much safer!: A second repeat prelabor cesarean section is 13 times less likely to result in fetal death as compared to attempted vbac! third and fourth (fifth etc) repeat prelabor cesarean sections are exponentially more dangerous for the mother but always safer for the baby when compared to attempted vbac. Only attempt vbac if your md agrees and you want >2 more pregnancies if you accept 1/200 risk of rupture. ...Read more
Lack of oxygen: If your uterus ruptures, the cord or fetal parts an be pushed out of the uterus into your abdomen. This dramatically cuts off the oxygen supply to the fetus. Depending on how quickly you have your emergency cesarean, the baby can be fine, permanently injured, or die. Just a few minutes is all it takes to make the difference. ...Read more
Uterus rupture/death: Failed trial of labor and repeat cesarean section is the most common risk when attempting vbac. It is in this subgroup of women with failed tolac and one prior kerr hysterotomy that the risk of uterine rupture is greatest reaching 15% (if oxytocin is used). When this dire labor complication occurs the fetus can die or sustain permanent brain injury. The mother is at risk for bleeding/infection. ...Read more
It be going on 2 years my son be 2 in January and a due date as of April 26, . .. A VBAC is possible. ....????
VBAC?: Your question is sporadic, but I think you are asking if you can have a VBAC with this 2nd pregnancy, assuming you had a C/section with the first. It depends on the pregnancy, MD experience, and type of C/section cut (transverse & not midline) in the uterus. Talk to your present OB MD for clarification, as he/she will be the one dealing with the possible medical consequences/complications. ...Read more
Why are some obs ardent supporters of vbac and others completely against them? I don't understand how there can be such a big discrepancy in opinion.
Comfort level: Opinions are variable due to physicians comfort level and training but also practice location. Most hospitals require in house coverage 24/7 if a patient is attempting vbac. Some physicians can not accomodate this. Also, patient history on why they needed a c-section plays a big part in supporting vbac attempt or not. ...Read more
Better find an MD OB: Cnms are supposed to deal with uncomplicated pregnancies and labor/deliveries. A trial of labor after prior cesarean section is a very high-risk situation that should only be managed by experienced obstetricians and perinatal anesthesiologists in large hospitals with sicu and nicu availability! Do not attempt vbac with midwife! ...Read more
Depends on situation: If your initial cs was due to big baby/small pelvis & you face the same with the next delivery a vbac may be unwise. If the initial cs was for breach or monitor irregularities & your pelvis is considered adequate by the ob, a vbac may be a reasonable choice. Discuss this with the OB & see what what your options are. ...Read more
Maybe: The American Congress of Obstetrics and Gynecology does consider a VBAC after two cesarean sections to be safe if: both uterine incisions were low transverse cervical and if there was no evidence of uterine rupture or a peritoneal "window" at the time of the second cesarean. The overall success rates of VBAC is approximately 75% but depends greatly on the reason for the cesarean sections. ...Read more
What are my chances of a successful vbac after 1 csec? What can I do to improve chances? I weigh 290 and prior csec was 18 months ago.
Exercise: If you are at beginning of pregnancy I suggest you have a great exercise, or walking program through your pregnancy and at 290, gain 15# or less for entire pregnancy. Avoid gestational diabetes. Of course in your situation, a vbac would be much preferred. 18 months is a short interval, so make sure you are monitored the entire time you are in labor at the hospital to be safe. Best wishes. ...Read more