by Dr. Michele Brown OB/GYN
The American College of Obstetrics and Gynecology in August 2010 has just issued brand new guidelines for allowing women with previous cesarean sections to undergo a trial of labor for a vaginal delivery. These "hot off the press" new recommendations were created in an effort to reduce the escalating cesarean section rate that has been plaguing American hospitals recently. Rates have spiraled from 5% in 1970 to 31% in 2007. Along with this statistic, it was found that VBAC rates have plummeted from 28.3% in 1996 to 8.5% in in 2006.
Of particular interest is the finding that although cesareans have increased in all states, there are large differences between the states. The lowest rates were found in Alaska, Idaho, New Mexico, and Utah. The highest rates were noted in Florida, Louisiana, Mississippi, New Jersey, and West Virginia.
What are some of the reasons behind this trend?
The biggest reported risk of vaginal birth after a cesarean is separation of the previous scar on the uterus (dehiscence) or complete rupture of the uterus which causes significant risk to both mother and fetus. The incidence of this is between .5 to .9%. Risks with rupture include maternal hemorrhage, need for transfusion, potential hysterectomy, and severe consequences for the newborn including possible death.
The risks of a cesarean are similar to the risks of any abdominal surgery. This includes:
The chance of success for a vaginal birth after a cesarean in a well chosen patient can be as high as 60%–80%. Patient and physicians should consider the following important questions when making a decision.