Seen on the Blogs – Comments on the Danger of VBAC
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.