Thursday, December 3, 2009

VBAC


A VBAC is a Vaginal Birth After Cesarean.  I first learned about VBACs from an article in Time magazine called The Trouble With Repeat Cesareans.

There is a great deal of controversy surrounding VBACs, and many hospitals do not give women who have had a previous c-section an option of a VBAC - its more cesareans only forever.  More than 9 out of 10 births following a C-section are now surgical deliveries.

The main risk associated with a VBAC is Uterine Rupture (because the mothers uterus has a huge cut scar running down it from her cesaren), which can be fatal to both mom and baby.

Here are the risks of Repeat Cesareans:
Heavy bleeding/hemorrhage
Increased risk of infection and infertility
Increased risk for hysterectomy and  uterine rupture in subsequent pregnancies
Increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth, such as placenta accreta (in which the placenta attaches abnormally to the uterine wall)
Here are some numbers:
1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)
          vs.
2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion's : 21.6% (1 in 5)

So why do doctors push repeat cesareans instead of risking VBACs?
Malpractice Insurance.
Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. "It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."

1 comment:

  1. Aghhhhh!!!!!! Yet another reason we need TORT REFORM! That is the STUPIDEST reason I've ever heard for doing repeat cesareans. I wish that nugget were more publicized... then maybe people would take tort reform more seriously when discussing health care reform in general. This is women's lives at stake!

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