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Seen on the Blogs – Comments on the Danger of VBAC

June 29, 2010

I recently read a blog comment elsewhere* in a thread that was related to birth choices in its way. The comment said:

“VBAC’s are not allowed by the hospital here because they are so extremely dangerous.”

Now, “so extremely dangerous” is a subjective description, but here’s what the recent NIH VBAC Consensus Statement has to say: “the vaginal delivery rate after trial of labor has remained constant at approximately 74 percent.” So 74% of the time, an attempted VBAC successfully results in a vaginal delivery.

And with regard to the oft-cited fear of uterine rupture:

“The risk of uterine rupture for women who undergo trial of labor at term is 778 per 100,000. …There have been no reported maternal deaths due to uterine rupture…For term pregnancies, the reported risk of fetal death with uterine rupture is less than 3 percent.”

So according to this report^, the risk of uterine rupture with a trial of labor is less than 1%. Among that <1% with uterine ruptures, the risk of fetal death is less than 3%. According to the report, maternal mortality is actually lower with a trial of labor (regardless of whether it results in vaginal or cesarean birth) than with elective repeat cesarean.

And yet, the perception out there is that it's "so extremely dangerous." And that the “extreme danger” to women/babies is why hospitals don’t allow it, rather than healthcare provider/system concerns about legal liability.

Even if we do get more nuanced and less restrictive recommendations out of the major medical association on VBAC, we’re going to have a lot of work to do walking back that “extremely dangerous” perception that was promoted along with the VBAC bans.

*I am not linking to where the comment came from, because that is not the place to have this argument right now. If you decide to search for the phrase and find it, please do me – and the author of the site – the courtesy of not picking a VBAC fight in that comment thread. If you know the story you'll know why, and if you don't know the story you definitely shouldn't start something there.

^See the free full text of the statement for more details about incision type and other factors related to provision and safety of VBAC attempts.

13 Comments leave one →
  1. QoB permalink
    June 29, 2010 12:52 pm

    thought that looked familiar. Hope I didn’t cross any lines – no desire to start anything on that site.

    • June 29, 2010 1:01 pm

      I thought your comment was very polite and measured, especially being directed to one of the other commenters instead of judging the author’s decision. I just don’t want anybody going from here to there and causing any additional stress for that family.

  2. June 29, 2010 8:07 pm

    I don’t have the reference to hand, but a year or two ago a study showed that VBAC was just about as dangerous … as any primapara giving birth vaginally.

    In other words, if we ban VBACs – or make them practically impossible due to hospital rules, insurance restrictions, etc. – we might as well ban all first-time mothers from giving birth vaginally.

    If I were a potential VBAC mother, I’d want to give birth in a hospital (not at home) because the risk of uterine rupture is one I wouldn’t want to mess with. That’s my personal risk calculus. But good grief. The idea gaining steam is that VBACs are practically murderous. That’s just absurd.

    Thanks for posting on this, Rachel.

  3. June 30, 2010 10:53 pm

    We all know that VBACs are safe, but like most common-sense things in regards to maternity care, it’s going to take much longer for it to catch on with the people who really need to grasp it (such as the whole “hey, women can now have CLEAR LIQUIDS during labor, because science has finally figured out that ice chips turn into liquid!”). So I like to keep repeating this mantra:

    If VBACs are so dangerous, STOP DOING SO MANY CESAREANS.

    Less Cesareans, less “extremely dangerous” VBACs with exploding uteruses and dead babies all over the place. (even though only a depressingly small number of Cesarean moms ever opt for VBAC at all)

    Ahhh, but I guess that’s just common sense talking again, and that’s something that’s unfortunately all too uncommon.

    • July 1, 2010 7:56 am

      “science has finally figured out that ice chips turn into liquid!” – that is hilarious, thank you.

  4. Heather Morado permalink
    June 30, 2010 11:13 pm

    i SOOO agree with If VBACs are so dangerous, STOP DOING SO MANY CESAREANS.

    i pushed 2 hrs with my son and ended up having a c-sections because he was “too big” he was 9lbs 7oz my old ob told me i could NEVER push out a baby more then 6lbs.. well on april 12th 2010 i pushed for 2 hrs 30 mins and delivery via vbac a 7lbs 15oz baby girl..

    my new ob said after looking at my labor report from my son and said that he was sunny side up and he doesnt see why i wouldnt of pushed him out

  5. Heather permalink
    July 1, 2010 12:00 am

    After being victimized by obstetric fear tactics (2 cesareans), you can imagine my rage when I discovered that the risk of uterine rupture for a VBAC is about the same as the risk of uterine rupture on an un-scarred uterus. And when a scarred uterus DOES rupture, it’s often not even along or close to the old scar line. A weak uterus is usually a hereditary thing and has little (maybe even nothing) to do with a scar.

    I’ve been had, and I’m pretty pissed about it. Just wanted to pass that information along. I read it in Natural Childbirth After Cesarean by Crawford and Walters. There are references in the back of the book, but none specifically linked to that statistic. If you wanted to find the actual data, that’s a good starting place.

    So much for “so extremely dangerous.”

  6. Shelly permalink
    July 1, 2010 12:45 am

    I am glad to hear that there are some more pro vbac moms out there and that there is the desire to educate more women and maybe even doctors on why vbac should be encouraged, not discouraged. I had a wonderful vbac after 2 c-sections, pushing for only 16 minutes, no complications whatsoever. Let’s stop scaring women and tell them the truth about vbac, and maybe how c-sections are not all they are cracked up to be! I am still having problems from my first two sections and that was 8 and 5 years ago! Less c-sections, more natural births!

  7. Kimrose permalink
    July 1, 2010 12:29 pm

    I don’t know if this is an appropriate place to post, but I’m looking for any HELP I can get! I recently found out that I’m pregnant with my 2nd🙂 and DESPERATELY need to find someone in our area who will support my VBAC. We’re central Massachusetts and would be very willing to travel to Boston if necessary… I had an all-natural labor w/my first to pushing when they realized he was breech and then emergency cesarean😦😦😦😦 I have a “T” incision with double layer sutures and it’s been almost 5 years since my cesarean. If anyone has any leads or advice on how best to find a provider, I’d be very grateful!!!!!
    Thanks,
    Kimrose

    • July 2, 2010 8:00 am

      I have an email in to some folks I know who live in the area; wanted to let you know I’ll pass along recommendations.

  8. July 1, 2010 5:14 pm

    Since I don’t know the back story, I won’t comment on that. But I was at least relieved to see the comment didn’t come from who I thought it did. (if that makes sense)

    To each her own … *sigh*

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