by Karen Doyle
“Once a cesarean, always a cesarean.” This may have been true in your grandmother’s day, or even in your mother’s day, but not any more. Now, most women who have had one cesarean delivery are encouraged to attempt to have a vaginal birth after cesarean—VBAC.
Cesarean section deliveries are typically performed in order to reduce the risk to the mother and/or the baby, should complications arise during labor. Previously, many obstetricians felt that a woman who had a cesarean with her first child should also delivery any subsequent children surgically. That perception is changing.
VBACs were first shown to be safe in 1980, which caused VBAC rates to rise. In 1999, in response to some complications, guidelines were changed to require that support people be “immediately available” if a VBAC was being attempted, which caused some hospitals to stop offering them.
In 2010, the American College of Obstetricians and Gynecologists (ACOG) released new guidelines for subsequent deliveries by women who have had a cesarean delivery in the past. ACOG has determined that a trial of labor after previous cesarean delivery (TOLAC) is safe and appropriate for most women, even if they have had more than one cesarean delivery. ACOG estimates that, assuming that candidates for TOLAC are identified appropriately, approximately 60 to 80 percent of women who have a TOLAC should have a successful VBAC.
The new guidelines have been well received by pro-VBAC organizations such as Lamaze International and the International Cesarean Awareness Network (ICAN).
Nearly one-third of all U.S. births now C-sections
According to ACOG, there were 1.3 million cesarean sections done in the United States in 2006, representing 31.1 percent of all births. The cesarean rate has been steadily increasing since 1970, when it was just 5.5 percent.
Conversely, the rate of VBAC births peaked at 28.6 percent in 1996, declining to just 7.9 percent in 2005. Mothers who choose to deliver surgically in order to have a “convenient” delivery date, along with hospitals’ concerns about lawsuits stemming from birth complications, are cited as reasons for the increase in cesarean births.
Why try for a vaginal delivery?
There are many reasons why a woman who has delivered one child by C-section will choose to attempt a TOLAC for a subsequent birth, according to Agnes Densmore, CNM, who as a certified nurse-midwife delivers babies at Jordan Hospital in Plymouth, Massachusetts. “Sometimes there is just the desire to give birth in the way that she feels her body was created to give birth,” she told Parent USA City. “She may feel that she missed out on experience that was her desire—or even her right—to have.”
Also, when you already have a child, parenting can’t slow down while you heal from a C-section.
“From a patient’s perspective, the recovery from a C-section isn’t easy,” said Brigid McCue, M.D., Jordan Hospital’s medical director of obstetrics and gynecology. “It’s major abdominal surgery and you are expected to be at 100 percent after the first week. People are shocked at the comparison between the first and second cesarean, because the second time you have a toddler running around.”
Expectant mothers have a say in the birth experience, and they should exercise that right. If a woman is getting a message of discouragement to have a TOLAC, she should question that, since it does not match the current advice from the American College of Obstetricians and Gynecologists.
Improving your likelihood of a successful VBAC
There are things a woman can do to increase her chances of having a vaginal delivery, according to Densmore. “The first thing a woman should do is research her health care provider,” she says. “Get an indication of what their primary C-section rate is.” A primary C-section is one performed on a woman who has not had a C-section before. “If they’re doing a lot of primary sections, that’s a clue,” Densmore says.
“Some practices, and some hospitals, do more than others. You should look for a rate between 15 and 20 percent overall. That’s a very good rate.”
Densmore also suggests considering a practice that includes physicians who collaborate with midwives. “Midwives like normal births,” she explains. “Practices that include both doctors and midwives have the advantage of giving a woman a choice as to who delivers her baby, depending on her preference and medical need.” Many physicians who collaborate with midwives are supportive of TOLAC and VBAC.
Dr. McCue said that Jordan Hospital had stopped doing VBACs, and she wanted to see them start again. “One motivation was that the National Institutes of Health said the women deserve a choice,” she said. “There’s no right answer, but women should have the choice. In order to offer that you have to have systems in place to ensure the delivery will be safe.”
Keeping yourself healthy will lower your risk of needing a C-section. “You need to educate yourself and do the work of pregnancy,” says Densmore. “Grow a healthy pregnancy in a healthy body. If you have high blood pressure or your weight is higher, you have a higher risk of having a C-section.”
Karen Doyle is a freelance writer who lives with her husband and three children in Scituate, Massachusetts. She writes on parenting topics and personal finance issues, as well as writing what she hopes is humor.
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