VBAC, Vaginal Birth After Caesareans, Complications, Evidence Review,
Caesareans, Multiple Caesareans
Objectives: This article was created to educate mothers and birth professionals on the evidence and facts about birthing after 2 or more caesarean sections. We also want to marry different evidence to decide whether having a VBAMC is a safe option.
Understanding: What is a VBAMC?
A VBAMC means a vaginal birth after many or multiple caesarean sections, and it is the same as a mother having a VBA2C, VBA3C, VBA4C or more.
Food for thought: Our founder had a VBAMC. In fact, I hope this will make you feel a little easier before you read this article. Our founder Chanelle Jaleelah Campbell had 2 caesareans and then 3 VBA2C. If your jaw isn't on the floor now, I'm sure it will be once you find out that her 5th birth was actually a successful HBA2C X3...... Now you know women are having VBAMC let's find out what the research says...
Introduction: We will unpack what the guidelines say to understand the safety of women birthing after more than 2 caesarean sections. Unfortunately, at the time of creating this article, there was a limited amount of data on VBAMC, but we hope in time we should see more guidelines and research papers blossoming into the spotlight. Today, we will reference the most significant studies on this topic, and we aim to answer 2 primary questions.
1. Should women attempt a VBAMC
2. What does the research say about women birthing after more than 1 caesarean section?
When deciding if a VBAMC is a safe option for you, you must take the time to do your research to make an informed decision. I know you have an emotional attachment to this situation, but it's equally important to stay balanced and try to remove any emotional attachment to make a balanced, logical decision.
There is so much conflicting anecdotal information circulating regarding birthing after multiple caesarean sections, but hopefully, this article will provide you with clarity and insight into your options moving forward.
The first thing you should think about is will your care providers support your VBAMC, and if they decline to, is there any medical literature available which proves having a VBAMC is a safe and appropriate choice?
The NICE guidelines state there is no difference in risk for women who have up to 4 caesarean sections compared with a woman who has 1 previous caesarean section, and she should be completely supported with her choice to have a VBAMC.
The ACOG practice Bulletin Guidelines #205 states there is limited data for women birthing after multiple caesarean sections. Still, after 2 caesarean sections, women birthing should be considered candidates for a TOLAC and counselled based on several factors that could affect their probability of achieving a successful VBAC.
RCOG Also state that there is very little difference in outcomes for women birthing with more than one previous caesarean delivery compared with a woman with one previous caesarean birth. If she has 2 or more previous lower segment caesarean deliveries, she may be a candidate for a VBAMC. She should have the support from a senior obstetrician to give her all her options and provide her with evidence-based facts to make an informed decision.
You can smile now...
So what does this mean, and how do you use this information?
It means your care provider has no reason unless you have a medical condition that would put you or your baby's life in danger, not to support your choice to have a TOLAC. They must provide you with all your options so YOU can decide what type of birth method (VBAC or Elective c-section) is best for you and your baby.
If your care provider begins to scare you into having an elective caesarean section forcefully, you have the right to decline and show them this article. Your care providers or physicians have no legal obligation over your choices, and you're entitled; in fact, it's your right to decline any treatment, procedure or choose whatever birth you want as long as it's safe.
Another well-known study states that women planning a Vaginal birth after many caesareans (VBAMC) should be again counselled appropriately. They go on to say a trial of labour after a previous caesarean delivery has been accepted as a way to reduce the overall caesarean rate and also to allow women a choice for mode of delivery "Tahseen and Griffiths (2009)
This is fantastic information for women birthing after a caesarean with a low segment caesarean scar (shown in the picture below). Although there's not much data on VBAMC, we are slowly uncovering the facts, which clearly proves the majority of women birthing after more than 2 caesareans will have a successful VBAMC, and contrary to some hospital policies, VBAMC is a safe option.
A study of 25,000 women with a prior caesarean section revealed something interesting. It shows us that when we compared women with one previous caesarean with women with 2 previous caesarean sections, there was not much difference in success rates.
This study states women who had one previous caesarean section had a 75.5% VBAC success rate compared with women with 2 prior caesarean sections who had a 74.6% success rate.
I know you're waiting to hear about the Uterine rupture risks. According to major studies, I can confirm that the uterine rupture risk remains significantly low even if you're birthing after multiple caesareans.
When we checked out a few studies, we managed to put uterine ruptures in women attempting a TOLAC after multiple caesareans into perspective.
The Landon (2006) study reported 9 women out of 975 women had a uterine rupture which works out to be a uterine rupture rate of 0.9%
The Macones (2005) study reported 20 women out of 1082 women had a uterine rupture which works out to be a uterine rupture rate of 1.8%
The Lin and Raynor (2004) Study reported a uterine rupture rate of 1.0%
This shows us that the uterine Rupture Rate is minimal, and women should not be scare mongered into believing that uterine rupture has a high occurrence.
A history of multiple cesarean deliveries is not associated with an increased uterine rupture rate in women attempting vaginal birth compared with those with a single prior operation.
In terms of uterine rupture, we are still waiting for a large scale study that speaks about the risks for women with multiple caesarean sections, but we know certain factors contribute to an unsuccessful VBAMC, VBAC.
When women undergo labour augmentation or labor induction, VBAC's chances become significantly reduced. (ACOG Practice Bulletin 115)
Other reasons for an unsuccessful VBAC include labor fetal monitoring, restrictive policies, and time constraints are among some of the reasons.
So should women plan a VBAMC?
Based on the research listed above, we can say the majority of women planning a VBAMC are candidates for a VBAMC and should look for a suitable VBAC supportive care provider to support and counsel them.
Another important thing to consider when planning a VBAC or a VBAMC is to make sure you do your research. It's imperative you know what the medical literature recommends and how your care provider reacts to these guidelines. Also what are the hospitals VBAC and VBAMC'S policies? Do they support VBAC? Are they pro inductions and augmentation of labor?
Don't walk in to this blindly. Are the hospitals you've chosen to birth your baby in supporters of intervening in the natural processes of labor? Google your care providers name and see what others have said about their policies and practices. What experience have other women gone through at that particular hospital?
If you like this article and find it useful, or perhaps you have a question or a suggestion, please leave us a comment below. We can't wait to hear from you...