VBAC study - help me work out why?....

[Beach Mama]

OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate. RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased. CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.

Ok so I'm going in tomorrow with my fisticuffs on armed with some studies about going overdue for a VBAC and the fact that it is SAFE, however the sucess rate isn't as high but none of them say why that occurs??? Could it be that caregivers are more ready to intervene with a c/s if you are post-dates? They already seem to be on eggshells with any VBAC so I can't see that being a significant factor??

Anyone have any insight???

ETA: Gotta love google! While trying to find some studies on VBAC beyond EDD I came across my Go Tan Go thread on BB!!!!!!!!

[Beach Mama]

Ah I think I found the answer in the full study. Even they aren't sure but it is possible that post-EDD women were counselled away from VBAC for fear of rupture after their DD even though the studies show there is NO significant increase in RR for women who are overdue. Also many who went overdue were VBA2C or more.....

Just putting in details for anyone else who comes across this predicament!

[MantaRay]

That's great info to have Tan. Best of luck with your appointment. You can do this hun.

[Tanya]

May also be that induction was not recommended for post dates and c/s was advised due to risk of rupture?

[~Aveta~]

first of all - Mods - i'm not sure if i can post this link, i re-read the guidelines and i believe i can, if not, please edit and let me know. apologies in advance if i'm in the wrong!


hi Tan, i was directed to this site today by the Doula i'm seeing in her capacity as a homepath (and if i ever get that far, i'm having her as my doula too!)


Birth Healing - Portal

i'm just scanning thru atm, but i've already found some very comprehensive information.

PS i had a VBAC after my twins birth was intervened with - one birthed V-way, the other twin emergency c/s, and i'm very glad i stuck to my guns and had the VBAC.

[~clover~]

I just wanted to say be strong & stick to your guns tomorrow hun! You can do this.

[Beach Mama]

Thanks all! I just wish DH or someone could be with me - ah well, will have to bring out the birthing tigress in myself as usual... I tend to get very defensive right off because I've built myself up for a big fight, whereas DH grounds me a bit when I'm like that and gives me time to breathe before speaking again.... Might have to remember my breathing while Im in there!

[Jennifer13]

Tan, you can fall on the right side of those %ages - it wasn't a 100% failure to have a VBAC post DD!

[Tobily]

Could it be that caregivers are more ready to intervene with a c/s if you are post-dates? They already seem to be on eggshells with any VBAC so I can't see that being a significant factor??

Anyone have any insight???

You got it hun.

Post 40 weeks women are more likely to experience significant pressure to agree to another caesarean, and if they go into labour will often have arbitrary time limits more stringently applied and experience stronger pressure to agree to interventions that directly impact on the success rate of vbac such as continuous monitoring.

[christy]

I had huge pressure to have a c/s. I was 41 weeks and told everything under the sun to push me towards a c/s. In the end I asked the OB to prove to me that my baby needed to come out NOW. I asked her for a scan to back up her info... and it showed a healthy near full term baby. Because Jovie measures 10lbs 11oz they wanted to do a c/s but I said no. She was born 2 days later 8lb 13oz.

Anyway at my hospital they did a study the following year that said in the last quarter of the year only 10% of women achieved their VBAC. Apparently it was different to the rest of the year when everyone was a bit above the percentages you've posted in that article... so in the last quarter they are more keen to cut?

[krisp]

Hi Tanstar, my VBAC Princess was 7 days over my EDD. My OB was very comfortable with this. We did briefly discuss waht might happen if I went past 10 days but she was very happy to reassess if and when we hit the 10 day mark and even then talk about ways to bring on a natural labour ie acupuncture, nipple stimulation, sex etc rather than the CS option. At no stage did she say there was a 'cut off' not did she ever pressure me to have a repeat CS.

I consider myself very very lucky to have such a supportive OB. But having said that at my very first visit with her I was very firm that I WASN"T having anaother CS and if that didn't sit well with her then I would find another OB.

Good luck Tanstar, I will keep everything crossed for you.