Full Circle Midwifery

If you have had a cesarean, your next baby can be born vaginally safely.  This is called a VBAC or vaginal birth after cesarean.

As Mona Lydon-Rochelle MD said at the 2010 National Institutes of Health VBAC conference, “There is a major misperception that TOLAC [trial of labor after cesarean] is extremely risky.”  George Macones MD asserted at that same conference, “Your risk [during a VBAC] is really, really quite low.”

The risk of uterine rupture in a spontaneous labor after one prior low transverse cesarean is 0.4% (Landon, 2004; Cahill, 2006).  The risk of maternal mortality in a VBAC vs. repeat cesarean is statistically the same, 0.02% vs. 0.04% (Landon, 2004).  The risk of infant death or brain damage during a VBAC is 0.05% which is “quantitatively small but greater than that associated with elective repeated cesarean delivery” (Landon, 2004).

The risk of infant death during a VBAC is “similar to the risk” of infant death for a first time mom (Smith, 2002).  Risk of miscarriage from an amniocentesis is 5 – 20 times greater than the risk of infant death or brain damage during a VBAC (March of Dimes, 2008; Landon, 2004).

A uterine rupture can be catastrophic, but it is rare (National Institutes of Health, 2010a).  The incidence of uterine rupture is comparable to other obstetrical emergencies such as placental abruption which has a worldwide rate of 1% and a 12% infant mortality rate (Ananth, 2001).

Successful VBACs have lower complication rates than planned repeat cesareans which have lower complication rates than “failed” VBACs otherwise known as CBAC (cesarean birth after cesarean)  (Landon, 2004).

An elective repeat cesarean section lowers your risk of uterine rupture in your current pregnancy, but it does not eliminate it.  Rupture can occur before labor or scheduled surgery.  Additionally, the risk of complications increase with each cesarean section including “placenta accreta, hysterectomy, transfusion of four units or more of packed red blood cells, [bladder injury], bowel injury, urethral injury, ileus [absence of muscular contractions of the intestine which normally move the food through the system], ICU admission, and longer operative time” (Silver, 2006).

The risk of uterine rupture decreases by 50% after your first VBAC (Mercer, 2008) and VBACs are successful 75% of the time (Coassolo, 2005; Huang, 2002; Landon, 2004; Landon, 2005; Landon, 2006; Macones, 2005).

In all 50 states, hospital and doctor attended VBACs are legal and in some states it is legal for a midwife to attend an OOH (out-of-hospital) VBAC.  Yet 57% of women interested in the option of VBAC are unable to find a supportive care provider or hospital (Declercq, 2006).  Other women schedule repeat cesareans based on false information.  Together these two factors contribute to the over 90% repeat cesarean section rate in America (Martin, 2006).

The cesarean section rate in America is 31.8% (Hamilton, 2009).  The World Health Organization (2009) indicates that at least half of these surgeries could be unnecessary and Declercq (2009) links our high cesarean rate with our high maternal mortality rate relative to other developed countries.

VBAC has risks. Repeat cesarean has risks.  Be sure to review the risks and benefits of your options with a VBAC supportive practitioner.  As the NIH VBAC Conference (2010b) concluded, VBAC is a “reasonable option for many pregnant women with a prior low transverse uterine incision.”

Learn more by reading Dr. Marsden Wagner’s Born in the USA, Ina May Gaskin’s Ina May’s Guide to Childbirth, Dr. Sarah Buckley’s Gentle Birth, Gentle Mothering as well as the NIH VBAC Conference Program and Abstracts and Draft Panel Statement.

Suggested articles from VBACfacts.com include: I’m pregnant and want a VBAC, what do I do?, The three types of care providers amongst OBs and midwives, Another VBAC consult misinforms, Homebirth vs hospital birth for the number cruncher, and Response to OB: Scare tactics vs. informed consent aka why I started this website.

Look for VBAC Classes presented by VBAC Facts in your area.

To purchase a summary of this information on a small business card for distribution, please see ourEducation page.

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Ananth, C. V., & Wilcox, A. J. (2001). Placental Abruption and Perinatal Mortality in the United States. American Journal of Epidemiology , 153 (4), 332-7.

Cahill, A. G., Stamilio, D. M., Obido, A. O., Peipert, J. F., Peipert, J. F., Ratcliffe, S. J., et al. (2006). Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery? American Journal of Obstetrics and Gynecology , 195, 1143-7.

Coassolo, K. M., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Nelson, D., et al. (2005). Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks Gestation.Obstetrics & Gynecology , 106, 700-6.

Declercq, E. R., & Sakala, C. (2006). Listening to Mothers II: Reports of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection.

Declercq, E. R. (September, 2009). Birth by the numbers . Retrieved from TheUnnecesarean: http://www.theunnecesarean.com/blog/2009/9/3/birth-by-the-numbers-on-updated-lamaze-video-library.html

Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2009, March 18). Births: Preliminary Data for 2007.Retrieved from Centers for Disease Control and Prevention:http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf

Huang, W. H., Nakashima, D. K., Rumney, P. J., Keegan, K. A., & Chan, K. (2002). Interdelivery Interval and the Success of Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology , 99, 41-44.

Landon, M. B., Hauth, J. C., & Leveno, K. J. (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. The New England Journal of Medicine , 351, 2581-2589.

Landon, M. B., Leindecker, S., Spong, C., Hauth, J., Bloom, S., Varner, M., et al. (2005). The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery.American Journal of Obstetrics and Gyne cology , 193, 1016-1023.

Landon, M. B., Spong, C. Y., & Tom, E. (2006). Risk of Uterine Rupture With a Trial of Labor in Women with Multiple and Single Prior Cesarean Delivery. Obstetrics & Gynecology , 108, 12-20.

Macones, G. A., Cahill, A., Pare, E., Stamilio, D. M., Ratcliffe, S., Stevens, E., et al. (2005). Obstetric outcomes in women with two prior cesarean deliveries: Is vaginal birth after cesarean delivery a viable option? American Journal of Obstetrics and Gynecology , 192, 1223-9.

March of Dimes. (2008, August). Amniocentesis Quick Reference Fact Sheet. Retrieved fromhttp://www.marchofdimes.com/professionals/14332_1164.asp

Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., & Kirmeyer, S. (2006). Births: Final Data for 2004. National Vital Statistics Reports , 55 (1), 1-102.

Mercer, B. M., Gilbert, S., Landon, M. B., & Spong, C. Y. (2008). Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstetrics & Gynecology , 11, 285-91.

National Institutes of Health. (2010a, March 8-10). NIH VBAC Conference: Program & Abstracts. Retrieved from NIH Consensus Development Program:http://consensus.nih.gov/2010/vbacabstracts.htm

National Institutes of Health. (2010b, March 10). Draft Panel Statement. Retrieved from NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights:http://consensus.nih.gov/2010/vbacstatement.htm

Silver, R. M., Landon, M. B., Rouse, D. J., & Leveno, K. J. (2006). Maternal Morbidity Associated with Multiple Repeat Cesarean Deliveries. Obstetrics & Gynecology , 107, 1226-32.

Smith, G. C., Pell, J. P., Cameron, A. D., & Dobbie, R. (2002). Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. Journal of the American Medical Association , 287 (20), 2684-2690.

World Health Organization, UNFPA, UNICEF and AMDD. (2009). Monitoring emergency obstetric care: A handbook. Retrieved from World Health Organization:http://www.who.int/reproductivehealth/publications/monitoring/9789241547734/en/

Last revised: 3/21/2010