From Susan Hodges:
VBAC should be widely available and is low risk for many VBAC hopefuls.
A just-published large study found that a woman with a prior cesarean but who has since given birth vaginally is at low risk for complications for herself and the baby, and with increasing number of prior VBACs has a greater likelihood of successful VBAC as well as lower risks for complications such as uterine rupture and perinatal complications for the baby. (Brian M. Mercer, et al. Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstet Gynecol 2008;111:28591).
Another recently published study concluded that: A history of multiple cesarean deliveries is not associated with an increased rate of uterine rupture in women attempting vaginal birth compared with those with a single prior operation. Maternal morbidity is increased with trial of labor after multiple cesarean deliveries, compared with elective repeat cesarean delivery, but the absolute risk for complications is small. [emphasis added] Vaginal birth after multiple cesarean deliveries should remain an option for eligible women. (Mark B. Landon,et al., Risk of Uterine Rupture With a Trial of Labor in Women With Multiple and Single Prior Cesarean Delivery Obstet Gynecol 2006;108:1220).
With each successive cesarean section, the risk of increasingly serious complications in the future rises. (Robert M. Silver, et al. Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries Obstet Gynecol 2006;107:122632). For women who were traumatized by their initial cesarean section experience or felt betrayed by their doctor or hospital staff, the hospital may be the least conducive setting for a successful VBAC, especially if the doctor or staff are unsupportive or unskilled in providing appropriate emotional support and encouragement. Furthermore, in many hospitals it is routine to induce or stimulate labor with drugs, even for VBACs, which significantly increases the risks of uterine rupture and other complications. (Brian M. Mercer, et al. Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstet Gynecol 2008;111:28591).
The Rise of Rural ‘Maternity Deserts’
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