Australian VBAC study published 2000

[BellyBelly]

Just wanted to highlight some points from an Australian VBAC study

[stone et al., 2000]

Results:

1 death in the VBAC group
1 death in the elective caesarean group

2 in 1,000 risk of uterine rupture - to put into perspective, the risks of congenital defects, SIDS, placental complications is greater than a baby dying from uterine rupture.

1: Paediatr Perinat Epidemiol. 2000 Oct;14(4):340-8.

Vaginal births after Caesarean (VBAC): a population study.Stone C, Halliday J, Lumley J, Brennecke S.

Perinatal Data Collection Unit, Public Health and Development Division, Department of Human Services, Victoria, Australia. christine.stone@dhs.vic.gov.au

This paper describes delivery outcomes for women from Victoria, Australia, who gave birth in 1995 and whose immediately previous (penultimate) delivery, within a 5-year search period, was a Caesarean section. Because of the large numbers of records involved, dedicated computer software for record linkage was used to identify the previous delivery and link it with the woman's current birth in 1995. Overall, 79% of the records from multiparous women were linked successfully. Approximately 15% were not linked because the previous birth was before the search period or was an abortion that would not have been reported to the Perinatal Data Collection Unit. Reasons for not being able to link the last 6% of the records include the previous pregnancy being overseas or interstate. Women who had a vaginal birth as the penultimate birth or a multiple birth at either event were excluded, resulting in a study population of 4663 linked records. More women (68%) had a repeat Caesarean than went into labour and, of the remaining women who laboured, 56% delivered vaginally. Overall, 18% of the women delivered vaginally. For the women who went into labour, the reported number experiencing a uterine rupture was two per 1000 births. Uterine rupture was not reported in the two-thirds who did not labour but had a repeat Caesarean. A review of the perinatal deaths identified only two deaths, one baby being born by elective Caesarean and one by a vaginal birth after a previous Caesarean (VBAC) where the choice of delivery methods may have contributed to the death. This large study is one of the few in the literature to provide population-based information on vaginal births after a previous Caesarean and related outcomes.

PMID: 11101021 [PubMed - indexed for MEDLINE]

What increases your risks:

* Induction and augmentation
* Surgical quality and technique
* Hospital policies e.g. ctg, cannualtion, epidural (masks pain of rupture)
* Lack of movement, lack of privacy, poor birthing environment for undisturbed birth
* Lack of understanding of what different women need in birth