Study: Vaginal Delivery Safe After Multiple Cesareans

Vaginal Delivery Can Be Safe After Multiple Cesareans

By David Douglas

NEW YORK (Reuters Health) Jul 11 - In women attempting vaginal birth after multiple previous cesarean deliveries, the risk of uterine rupture is no greater than in women who have had only one previous cesarean delivery, researchers report in the July issue of Obstetrics and Gynecology.

The author of an accompanying editorial, Dr. Vern L. Katz, from the Center for Genetics and Maternal-Fetal Medicine in Eugene, Oregon, told Reuters Health that this "is exactly the type of evaluation we need to help advise women on the relative safety and relative risks of both repeat cesarean delivery and trials of labor after cesarean. Each woman's situation is specific and advice should be individualized for those specifics."

In the study, Dr. Mark B. Landon of Ohio State University College of Medicine and Public Health, Columbus, and colleagues prospectively examined data for women attempting vaginal birth after a single or multiple cesareans.

Uterine rupture occurred in 9 of 975 women who had had multiple prior cesareans (0.9%) and in 115 of 16,915 women with a single previous cesarean (0.7%), a nonsignificant difference.

However, the rates of hysterectomy were significantly increased in the multiple cesarean group (0.6% versus 0.2%), as were transfusion rates (3.2% versus 1.6%).

Similarly, a composite of maternal morbidity, including endometritis and operative injury, was significantly increased in women who had had multiple cesareans.

Despite this increased risk of complications, the absolute risk is small, the researchers conclude, and "vaginal birth after multiple cesarean deliveries should remain an option."

Dr. Katz added that there is a "shifting paradigm of cesarean, not as an adverse outcome -- a complication -- but as one tool towards achieving the goal of a healthy mother and baby."

"Thus," he concluded, "the studies that we need, like Mark Landon's, help provide guidelines in the best use of the tool."

Obstet Gynecol 2006;108:2-3,12-20.

Awesome information. Thanks heaps. I was wondering what the chances of having a VBAC considering I have now had two. My first born was c-sec and now my 6th born was also a c-sec. Great to know that if i ever end up pregnant again hopefully i would be able to try another vbac.
Thanks for this insight

That's good to know the option is there after two caesarians....

The problem is we don't know the full story around this birth. It is not recommended, and I have never heard of an Ob before who will induce for a VBAC. It increases the risk of rupture. You can rupture with an induction - no matter if you have had a c/s or not before. So adding that rupture risk on top of the VBAC risk of 0.7%.

We all hear bad or scary stories but we never know the full story to be able to understand properly...

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Awesome information. Thanks heaps. I was wondering what the chances of having a VBAC considering I have now had two. My first born was c-sec and now my 6th born was also a c-sec. Great to know that if i ever end up pregnant again hopefully i would be able to try another vbac.
Thanks for this insight

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How funny that i looked this up now and to read my own words!!!! As fate would have it I fell PG just after i was in here! Mind you i didn't realise for just over 5 weeks,i had symptoms galore but just thought my body was still out of whack after my c-sec!!!!!! A gf told me i was PG which i laughed at, then later did a test and got a BFP!!! So now i am on this roller coaster ride of wantinga VBA2C and definately didn't get the support from the doc who did my last c-sec!!!! At first this upset me greatly, but now i have had time to cry and get my head clear, i will be fighting him on this! As he said if I choose to not come in until i am in labour they have no choice but to help me birth my baby!!!!!
I have had one health nurse tell me not to let them bully me into a repeat c-sec so that was wonderful.:dance: I have my next appointment with MW on the 7th Nov so will be talking to her and finding out how she feels about it all and if need be i will be showing her that i have done my research and know the facts and figures!!!!!!

Anyway just thought i would pop in and put my thoughts out there! If this is not the pace for it then please feel free to move it. Thanks

Cheers
Kat

Wow... it helps to be informed... i am due with no.2 at Christmas, and after a c-section with no.1, i am a little unsure about the best option for me. Thanks for the interesting comments though, everyone!

easier to find a supporting midwife rather than force one into changing their believes?

I meet my ob today and he seems to be very supportive if I wanted to go down that path, but I am going with an elective c-section far less risk and problems for me with time

if i fall preggers after ivf next year i'm going to see if i can have VB after having 3 cerareans hopefully i can

sarah

At my first hospital appt I stated my position, that statistics back me up that VBAC need be treated no differently to VBAC 1, and was told firstly that statistics are not everything, (he asked me if I would cross a road knowing that I had a 9/1000 chance of being hit - I wish I had thought quick enough to say all the things that I thought of later) but he continually came back to the notes in my vbac saying I had a bilateral extension down inferiorly on both angles, and this put my risk much higher anyway, that in his opinion I would rupture and did I understand the consequences of that, what does this mean, I tore during my last birth, could I get some reassurance or unbiased advice on what potential impact could have on my vbac2!!
Thank you
Kate
Kate

I would love it if i could find an OB who will allow a VBA3C next time round....we will start our IVF adventure DEC'09 and hopefully fingers crossed be able to have a VBA3C....

That's awesome news! I have had two caesars already (1st and 3rd child, 2nd was vbac :p)

I was wondering if it would be ok after 2 c-sections, but sounds like the go. Ofcourse i have to hope no 4 baby is a head down baby. Both my girls were breech and caesars. Maybe the boys don't like sitting that way? hehehe I can only hope this one is a boy and goes head down. Well...I find out in one week hopefully!!

Hi everyone,

I am 38 weeks today, and had a ctg last night and this morn cause bubba decided to have a really long nap and worry mummy!! But all is good. Bad news is that they want to send to KEMH in Perth to have bubba. I am trying for VBA2C and am being told that they "don't have the facilities" here for that, and that none of the midwives will be allowed to care for me in labour if i go early. Im devastated :crying: to say the least, poor hubby doesn't know what to do. He is supportive of my choice though, love him for it.
Any idea on what I can do. I don't want to fly to Perth to have babe, I have other kids etc to consider. They are saying if I go into early labour they will CS me straight up. Can I refuse??? And they can't refuse to admit me/care for me can they???

Cheers for ears

I was refused a vba2c at my local hospital as they don't have the expertise or whatever. They basically told me c-section or change hospitals! I have changed hospital (to the Mater in brisbane, in the city).

If I couldn't get my vba2c, I was going to stay home in labour as long as possible. The Dr did say if I turned up 10cm dilated, they were hardly going to make me have a c-section. But maybe they could if you arent' dilated enough? I was considering a home birth also. Midwives are very supportive of it (vbac).

You need to sign consent for them to do any operation. So, maybe if you refuse to sign, then that is your only option? I wish you luck!! It's a shame you are so far away from Perth.

Actual medical evidence shows that the difference in risk of uterine rupture (the big bogeyman and justification for the insistence on the CS) from 1 previous CS to 2, (so long as we are talking about Lower Uterine Transverse Scar) is negligible, so if it is acceptable to go through a trial of scar after 1, there is no reason not to try after 2, or even 3...... I am 38 weeks and going for my VBA2C.... and no ob has been able to give me any medical reason not to, they mumble and say that they are not comfortable with it. Well, that is their bad luck!! The increased risk of hysterectomy is bigger once you have had multiple CS, but then that increases whether the CS are voluntary (elective) or emergency so again is not a reason to factor in. As Henci Goer says, just say no, unless the risks of not doing the intervention outweigh the risks of doing it. When they say they don't have the facilities, they mean that they may not be able to give you an emergency CS within 30 mins of a rupture occuring, but with any birth things can go wrong, from memory the WHO's stance is that a reasonable CS rate in a developed country is about 7 or 8% (please correct this if I am wrong) which means that in any birth you may need to have a CS quickly, is the hossie saying that they cannot accomodate this, so they cannot manage this % of their maternity patients, and you are only potentially 0.9% of that!! I hope I make sense, good luck with it however it goes!! I"ll post my story on once I have had bub!!
Kate

Good luck Kate.

I'll be going for a VBA2C - not for a while though - and my OB is completely in support of my choice.

cheers for the support. have been talking with hubby, and have decided that we still want to try, so i'm going back to hosp tomorrow to do some nagging. Their excuse was that the midwives won't be allowed/covered or something to care for me if i go in during labour, and that they don't have the facility for an emergency csect if i rupture. { my take on that is that is crap, as they are the major hospital up here (Port hedland) and even take karratha girls (and that towns at least 3-5 times bigger than us!!). } Apparently don't have the blood stores etc (again crap). So we are going to try and encourage her to come by end this week, and labour at home as much as possible (unfortunately no independent midwives up here), and then go in when they can't stop me. Doc just gonna have to deal with it.

The question is though, how on earth do I find someone that is willing to allow me to give it a go?

Monday - you could try finding an independant midwife and then asking her if she has any knowledge of OB's preferring to section instead of VBAC?

hey monday

nag the daylights out of your ob, if they won't they will know of someone who will. depends which hospital, i had to fly to perth from regional WA for mine. if they have the facilities (and most major hosps do), and you are not a high risk for vba2c then they should let you have a go. My attempt failed, but I had another long slow labour with not good signs and in the end gave in to the pressure. make sure you have support people who will help you, but remember that in the end you need a healthy bubba. Best of luck hun xo

Arimeh, do you think I'd be able to do a ring around to private midwives & see if they can give me any information even though I'm not pregnant yet? I just don't want to be stressing about everything when I do fall pregnant.

Mandy, I have my husband who was an excellent support last time, the first time we were both exhausted (36hr labour) and scared. My doula plans for my VBAC fell through unfortunately, but I plan on organising one for the next time for sure.

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Arimeh, do you think I'd be able to do a ring around to private midwives & see if they can give me any information even though I'm not pregnant yet? I just don't want to be stressing about everything when I do fall pregnant.

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I can't see why not. I contacted a lot of independent midwives when I found out I was moving to tassie to see if I could get a recommendation from someone for a good one down here - and then I found the birth centre through one of the girls off here. I just emailed though, didn't ring.

best of luck girls. i'm deleting my profile now. i didn't realise how much emotion was still attached to the subject. I hope you both succeed in fulfilling your dreamxoxo

Thanks Arimeh, I will try emailing a few :)