CAESAREAN MYTH NO. 2
Once a caesarean, always a caesarean
After one caesarean section, VBAC (pronounced vee-back – vaginal birth after caesarean) is widely accepted as appropriate and safe. However, after two or more caesareans, it is common policy for a mother to be automatically scheduled for an elective (planned) caesarean since it is believed that the risks of caesarean scar rupture increase with the number of caesarean operations.
Lack of evidence supporting this theory has led some researchers and obstetricians to question the basis for this accepted practice.8,9 Indeed, the highly respected Guide to Effective Care in Pregnancy and Childbirth concludes that: ’...the available evidence does not suggest that a woman that has had more than one previous caesarean section should be treated any differently from the woman who has had only one caesarean section’.10
While the number of obstetricians willing to support a mother through labour after two caesareans is believed to be small, that number does appear to be increasing, leading the authors to believe that the tide may be turning in this respect. However, it is rare to hear of a vaginal delivery after three sections and the authors know of no cases in this country following four or more caesareans, although cases have been documented in the United States.
One reason for such low numbers of vaginal deliveries after multiple caesareans is the low parity in this country and it is known that women who undergo caesarean operations tend to have fewer children than average, although the reasons for this are not clear.
It must also be accepted that many women who have had multiple caesareans will have no desire to embark on a labour, having come to terms with the caesarean section as a mode of delivery, and who may well have come to prefer the caesarean way of birth. Others may well take the attitude ‘better the devil you know’.
Consequently, the chances of an obstetrician encountering a woman in her fourth or subsequent pregnancy, who has had three or more caesarean sections and is well motivated to achieve a vaginal delivery, are slim at best, and he is unlikely to do so many times in his career. So few obstetricians are confronted with such a situation that knowledge of the true risks, or rather the lack of them, is sparse, and the confidence that comes with experience totally lacking. Individual mothers who wish to avoid further caesarean operations must therefore have access to information from other sources in order to facilitate truly ‘informed choice’.
feeling completely deflated (VBAC)
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I hope that Kelly's info helps you some...
Also try birthrites.org and click, literature of interest.
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