NIH to Recommend VBACs: Vaginal Birth After Cesarean

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I have many friends and family members that have delivered their first babies via Cesarean surgery.  Subsequent births were scheduled c-sections; the mothers were given no choice in the matter. Only one of these women actually experienced a vaginal birth after Cesarean (VBAC) delivery, and that was because she went into labor before her scheduled surgery.  The idea that once a Cesarean always a Cesarean is changing, as international experts agree labor should be attempted by all women.  The question is…will US insurance companies allow women to try?

According to Reuters India, experts told the National Institute of Health (NIH):

The experts cited “rigorous research” showing that at least trying natural labour is successful in nearly 75 percent of cases, and women are less likely to die if they are allowed to labour naturally for a while, even if they end up delivering surgically.

“Declining vaginal birth after Caesarean rates and increasing Caesarean delivery rates over the last 15 years would seem to indicate that planned repeat Caesarean delivery is preferable to a trial of labour,” Dr. F. Gary Cunningham, chairman of the NIH expert panel, said in a statement.

“But the currently available evidence suggests a very different picture: a trial of labour is worth considering and may be preferable for many women,” added Cunningham, the chairman of obstetrics and gynaecology at the University of Texas Southwestern Medical Centre at Dallas.

Statistically, 40 percent of C-sections in the US occur in women with previous surgical births.  Many doctors and insurance companies fear previous incisions will burst during labor; however, this occurs in only one percent of VBACs.

A draft statement on VBACs by the NIH is suppose to be released tonight.  It is expected they will recommend all women be given a chance at vaginal birth no matter past labor experiences.  In the structured abstract for Vaginal Birth After Cesarean: New Insights, Agency for Healthcare Research and Quality, part of the US Department of Health 7 Human Services, concludes:

Each year 1.5 million childbearing women have cesarean deliveries, and this population continues to increase. This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans. Relatively unexamined contextual factors such as medical liability, economics, hospital structure, and staffing may need to be addressed to prioritize VBAC services.

Comments

  1. I picked my CNM for 2 reasons: I loved her, and I loved the OB/GYN she worked for so I had the best of both worlds. I had a c-section when my daughter was born b/c her heart rate was dipping severely because of the contractions brought on by the attempted version. I knew I had made the right choice for my team when the OB/GYN came in after my failed version and it was clear I was going to have to have a c-section because my daughter was breech & the position she was in would have had her coming out butt first…which doesn’t work. He came in, I was crying, and reassured me several times that even though this birth was going to be a c-section, that didn’t mean my next one had to be. That is sooo unusual in this country. It was so reassuring. The only way I won’t use this birth team again is if I can have a home birth.

    I’m not a fan of the Duggars (18 kids & counting) but I did watch one episode where she was talking about each of her births. She has had several c-sections, but has also had multiple VBAC’s, several of them at home. If she can have that many VBACs and have them after more than 1 c-section, that’s proof enough for me that it’s worth trying.

  2. I was trying to come out butt-first too, so my mom had an emergency c-section with me. Two years later she had a VBAC with my brother. The other day I mentioned VBACs when discussing the raising birthing-mother mortality rate, and she’d never even heard the term, and didn’t know that VBACs were “controversial.” She said they were the norm when she had us, and it wasn’t even an issue. Now, I’m 28, so it’s not like this was so long ago. It amazes me that things have changed so much in such a short amount of time.

  3. Once again I’m SO glad I live in the UK. Just try and tell me I don’t have a choice over *anything* to do with my own body.

    I can’t quite believe what I have just read in the above two comments: Butt first doesn’t work?! Who told you that? Breech means just that – butt first! I’m really saddened that this is the kind of misinformation and ignorance women are subjected to in such supposedly advanced countries. All I can say is never blindly believe everything you are told, ask questions, be bolshy and above all; do your own extensive research before making any decisions! An uninformed decision is not a decision at all.

    Well worth checking out is Mary Cronk’s ‘Hands off the breech’ article: http://www.aims.org.uk/Journal/Vol10No3/handOffbreech.htm

  4. Even when Dr’s are trained and skilled at breech births most often they aren’t done because the insurance companies won’t cover it. That was the case here. My Dr. knew how to do it but would have been dropped by his insurance.

  5. Breech was the reason for my second C-section too. Would have been a VBAC without it, but many OBs for one reason or another won’t do breech. It’s sad, but that’s what we get stuck with.

  6. eli's mom says:

    I think it’s awesome when a woman has a successful VBAC. I wish I could be given that chance, but I will never be able to. Reason being is that I am a very small woman with a very, very narrow pelvis. When my son was born at barely over 6lbs, he wouldn’t fit out! So, I had no choice but to go the c-section route. It is very unlikely, in my case, that I will ever be able to have a vaginal delivery, but for all those woman who don’t have anatomy working against them, a VBAC should definitely be the first option.

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