| Your last birth may have resulted in a cesarean section but that does not mean this pregnancy has to end in a repeat cesarean. It's the woman's choice to birth vaginally or choose an elective repeat cesarean. We will provide you with the information you need to make an informed decision. Women who previously had a cesarean should go through labor and have a vaginal birth but unfortunately some medical professionals are all too willing to grant a request from a patient for a repeat cesarean even when most of the time the repeat cesarean is not medically necessary. The fact you had a previous cesarean is not a medically necessary reason by itself to have a repeat cesarean. Over twenty years of medical research on thousands of women have led the American College of Obstetricians and Gynecologists to agree that in the absence of a specific reason for cesarean section, the routine policy for women with prior cesareans should be labor. The United States is the only country where VBAC isn't the norm. The VBAC rate in the U.S. is rising, however. Still an alarming number of women who had a prior cesarean are electing to have a repeat cesarean most of which do not have a medical reason to do so. |
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Trusting Our Bodies
For more information on The Bradley Method®, for an international listing of instructors or to contact the American Academy of
Husband-Coached Childbirth® directly, please contact: The Bradley Method®, Box 5224 Sherman Oaks, CA 91413-5224, 1-800-4-A-BIRTH
or 1-818-788-6662, www.bradleybirth.com
Husband-Coached Childbirth® directly, please contact: The Bradley Method®, Box 5224 Sherman Oaks, CA 91413-5224, 1-800-4-A-BIRTH
or 1-818-788-6662, www.bradleybirth.com
| SPECIAL BEGINNINGS BIRTH CENTER MIDWIVES PRACTICE WILL DO VBACS BUT ONLY AT THE ANNE ARUNDEL MEDICAL CENTER: There is an excellent team of midwives practicing at the Special Beginnings Birth Center in Arnold, Maryland (located near Annapolis) that enjoy assisting VBAC mothers. (If you live an hour away, do not fear; it's worth the drive!!) A few years ago after the ACOG changed their wording on VBACs from having an OR readily accessible to immediately accessible, the birth center changed their policy of allowing VBACs in the birth center to attending VBACs only in the hospital. SBBC midwives though have tons of experience catching babies at the Anne Arundel Medical Center and have the Annapolis OB/GYN group backing them up if the need for an OB or surgical birth arises. The AAMC has a Level III NICU and is staffed with L&D nurses accustomed to assisting in hospital births with the SBBC midwives. AAMC requirements/SBBC policy for VBAC patients:
The SBBC midwives have NEVER had a mother's uterine scar rupture during a VBAC. EVELYN MUHLHAN, CNM - VBAC: She provides gynecological care, prenatal care and birth care. She will travel to a client's home that lives within 1 1/2 hours of Baltimore City. She does more VBAC births each year. She has NEVER had a mother's uterine scar rupture during a VBAC. www.altbirthchoices.com Her contact info: (410) 455-9659 4 East Rolling Crossroads, Suite 207, Caytonsville, MD 21228 MIDWIVES AT MERCY HOSPITAL WILL DO IN-HOSPITAL VBACs: The midwives at Mercy Hospital - the Kathy Slone Group will catch VBAC babies. In 2004, their VBAC rate was 100%. They have only ever had one VBAC uterine rupture that ended in cesarean but both baby and mother were fine. They also do water births but VBAC patients may not use the birth tub. Electronic monitoring is required but a continuous IV or heplock is not required. VBAC mothers may drink during labor but a decision is made on a case by case basis as to whether she may eat during labor which is based on the individual herself and what stage of labor she is in. Women who must have a cesarean can still have their prenatal care with the midwives and they will have their cesarean performed by their back-up perinatologist, Dr. Atlas. However, the midwives at Mercy do not recommend cesarean unless it is absolutely necessary. Their contact info: (410) 235-0506, 3501 St. Paul St #143, Baltimore, MD 21218 WISDOM MIDWIFERY AT WASHINGTON HOSPITAL CENTER WILL DO IN-HOSPITAL VBACs: Whitney Pinger, CNM can catch VBAC babies at Washington Hospital Center where she has privileges. She provides gynecological care, prenatal care and birth care at Washington Hospital Center. She was on the forefront of the VBAC movement in the late 70’s early 80’s and has helped hundreds of VBAC mothers with about a 90% success rate. She does not induce VBACs and is loathed to use pitocin at all but will in active labor, if needed. She encourages natural, normal labor and has had 5 homebirths herself. She has seen uterine rupture over her 30 years of practice. Then, again, she's seen it all! WHC imposes hospital rules about continuous EFM, IV, etc... Her clients need to work with the rules of the hospital because she is on the medical faculty at WHC and the doctors are her colleagues, so she is careful to avoid getting into adversarial situations. There are no tubs for water births or laboring in water. Her contact info: (202) 255-3108, wpinger@verizon.net MIDWIVES ATTENDING VBACs AT HOME: There are many midwives in our area offering homebirth assistance to couples seeking to VBAC even VBAC after multiple cesareans. I have a list of midwives for any VBAC couple interested in homebirth. Please contact me to request a list of midwives who can also assist with homebirth VBACs. I'm continuing to interview providers to add to this list. If you've experienced a successful VBAC with a doctor or midwife and they have a high rate of VBAC success, please let me know! Check back to see if more are added soon! (Edited June 2008) |
| INSPIRATIONAL VIDEOS Be inspired! These are must-see video montages for any woman seeking a VBAC! Journey to Homebirth - VBA3C!! In the above 2006 birth story, a VBAC mother tells her inspiring story of how she wanted a vaginal birth so much and after her first three births ended in cesarean section, she finally got her wish the fourth time around! Not only did she finally get her vaginal birth after 3 cesareans, her water broke and she did not go into labor immediately - no contractions - so she only subscribed to natural induction remedies and two weeks after her membranes ruptured(ROM), she had a successful homebirth!! A truly amazing story! Another amazing VBA3C in 2008 after three unnecessary cesareans giving birth to their fourth child at home with a midwife - Iris' Story. Trusting Our Bodies will make our childbirth dreams come true and will result in a healthy baby, healthy mother and healthy family! |
Cesarean & VBAC Support! ICAN Online Support Group Birth After Cesarean Support DC Cesarean Support Group MD Cesarean Support Group NoVa Cesarean Support Group Cesareans increase the risk of the mother dying by 3 to 4 times! |
| Women who normally go beyond 40 weeks of pregnancy before naturally going into labor can safely have a VBAC! Obstetrics and Gynecology 2005 Oct;106(4):700-6. Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. Coassolo KM, Stamilio DM, Pare E, Peipert JF, Stevens E, Nelson DB, Macones GA. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. kcoassolo@obgyn.upenn.edu OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate. RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased. CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased. |
| A woman who has a VBA2C is only slightly more at risk for major complications than a woman who has a vaginal birth after only one cesarean. Also, VBA2C women are also slightly more at risk for major complications than women who elect repeat cesarean after two cesareans. However, the risk of major complications for VBA2C is still very low. American Journal of Obstetrics & Gynecology 2005 Apr;192(4):1223-8 Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option? Macones GA, Cahill A, Pare E, Stamilio DM, Ratcliffe S, Stevens E, Sammel M, Peipert J. Departments of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA. gmacones@mail.obgyn.upenn.edu OBJECTIVE: This study was undertaken to compare clinical outcomes in women with 1 versus 2 prior cesarean deliveries who attempt vaginal birth after cesarean delivery (VBAC) and also to compare clinical outcomes of women with 2 prior cesarean deliveries who attempt VBAC or opt for a repeat cesarean delivery. STUDY DESIGN: We performed a secondary analysis of a retrospective cohort study, in which the medical records of more than 25,000 women with a prior cesarean delivery from 16 community and tertiary care hospitals were reviewed by trained nurse abstractors. Information on demographics, obstetric history, medical and social history, and the outcomes of the index pregnancy was obtained. Comparisons of obstetric outcomes were made between women with 1 versus 2 prior cesarean deliveries, and also between women with 2 prior cesarean deliveries who opt for VBAC attempt versus elective repeat cesarean delivery. Both bivariate and multivariate techniques were used for these comparisons. RESULTS: The records of 20,175 women with one previous cesarean section and 3,970 with 2 prior cesarean sections were reviewed. The rate of VBAC success was similar in women with a single prior cesarean delivery (75.5%) compared with those with 2 prior cesarean deliveries (74.6%), though the odds of major morbidity were higher in those with 2 prior cesarean deliveries (adjusted odd ratio[OR] = 1.61 95% CI 1.11-2.33). Among women with 2 prior cesarean deliveries, those who opt for a VBAC attempt had higher odds of major complications compared with those who opt for elective repeat cesarean delivery (adjusted OR = 2.26, 95% CI 1.17-4.37). CONCLUSION: The likelihood of major complications is higher with a VBAC attempt in women with 2 prior cesarean deliveries compared with those with a single prior cesarean delivery. In women with 2 prior cesarean deliveries, while major complications are increased in those who attempt VBAC relative to elective repeat cesarean delivery, the absolute risk of major complications remains low. |
| Obstetricians should make it clear when informing their patients that VBAC is safer than an elected repeat cesarean! American Journal of Obstetrics & Gynecology 2006 Oct;195(4):1143-7 Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery? Cahill AG, Stamilio DM, Odibo AO, Peipert JF, Ratcliffe SJ, Stevens EJ, Sammel MD, Macones GA. Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, USA. OBJECTIVE: This study was undertaken to determine whether vaginal birth after cesarean (VBAC) or elective repeat cesarean delivery is safer overall for a woman with a prior vaginal delivery. STUDY DESIGN: This retrospective cohort study of pregnant women from 1996 to 2000 who had a prior cesarean delivery, was conducted in 17 centers. Trained nurses extracted historical and maternal outcome data on subjects by using standardized tools. This planned secondary analysis examined the subcohort that had also previously undergone a vaginal delivery, comparing those who underwent a VBAC trial with those who elected to have a repeat cesarean delivery. Outcomes included uterine rupture, bladder injury, fever, transfusion and a composite (uterine rupture, bladder injury, and artery laceration). We performed bivariate and multivariable analyses. RESULTS: Of 6619 patients with a prior cesarean delivery who had also had a prior vaginal delivery, 5041 patients attempted a VBAC delivery and 1578 had an elective cesarean delivery. Although there was no significant difference in uterine rupture or bladder injury between the two groups, women who underwent a VBAC attempt were less likely to experience the composite adverse maternal outcome, have a fever, or require a transfusion. CONCLUSION: Among VBAC candidates who have had a prior vaginal delivery, those who attempt a VBAC trial have decreased risk for overall major maternal morbidities, as well as maternal fever and transfusion requirement compared with women who elect repeat cesarean delivery. Physicians should make this more favorable benefit-risk ratio explicit when counseling this patient subpopulation on a trial of labor. |
| Vaginal Birth After Cesarean |
| VBAC Research |
| It is safe for women who gave birth to twins via cesarean to have a VBAC with her next pregnancy! Women who gave birth to twins via cesarean and want to attempt a VBAC are no more likely to have their VBAC result in a cesarean, experience uterine rupture or experience a major maternal morbidity than a woman attempting a VBAC after a singleton pregnancy resulted in a cesarean. American Journal of Obstetrics & Gynecology 2005 Sep;193(3 Pt 2):1050-5 Vaginal birth after cesarean (VBAC) attempt in twin pregnancies: is it safe? Cahill A, Stamilio DM, Pare E, Peipert JP, Stevens EJ, Nelson DB, Macones GA. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, USA. acahill@mail.obgyn.upenn.edu OBJECTIVE: The purpose of this study was to compare the rate of vaginal birth after cesarean (VBAC) attempt, VBAC failure, and major maternal adverse outcomes in women with a previous cesarean with twin or singleton pregnancies. STUDY DESIGN: This was a multicenter retrospective cohort study between the years 1996 and 2000. Subjects were identified by ICD-9 code. Trained research nurses collected medical record data on the outcome of VBAC attempts, and clinical outcomes, including uterine rupture and major operative injuries. We used bivariate and multivariable techniques to assess the association between twins and the outcomes. RESULTS: Of 25,005 patients with at least 1 previous cesarean, there were 535 twin pregnancies and 24,307 singleton pregnancies. Compared with patients with singleton gestations, patients with twins were less likely to attempt a VBAC (adjusted odds ratio [AOR] 0.3, 95% CI 0.2-0.4), but no more likely to have a VBAC failure (AOR 1.1, 95% CI 0.8-1.6), a uterine rupture (AOR 1.2, 95% CI 0.3-4.6), or a major maternal morbidity (AOR 1.6, 95% CI 0.7-3.7). CONCLUSION: Women with twin gestations are less likely to attempt a VBAC, but they are no more likely to fail a VBAC trial or experience a major morbid event compared with women with singleton gestations. |
| Several studies report VBAC rates around 70%, so your doctor or midwife should have a VBAC rate no less than 70%. Valid reason not to do a VBAC:
These are not good reasons to deny a woman who wants to have a VBAC:
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Recommended Reading about Cesareans and VBACs:
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In Maryland in 2007, 3 women died due to complications from cesarean section - one at 5 days pospartum due to infection, one at 7 days pospartum due to blood clots in her legs, and one in her recovery room immediately after surgery! More U.S. Women are Dying |
Maryland VBAC Birth Attendants/Birth Places
| You can successfully VBAC with a baby suspected of being 8lbs, 13oz in weight or more! Babies over 9lbs, 6oz can still be born vaginally after cesarean with a 60% success rate! Outcomes of trial of labor following previous cesarean delivery among women with fetuses weighing >4000 g (8lbs, 13oz). Zelop CM, Shipp TD, Repke JT, Cohen A, Lieberman E. Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA. OBJECTIVE: To compare outcomes at term of a trial of labor in women with previous cesarean delivery who delivered neonates weighing > 4000 g versus women with those weighing < or = 4000 g. STUDY DESIGN: We reviewed medical records for all women undergoing a trial of labor after prior cesarean delivery during a 12-year period. The current analysis was limited to women at term with one prior cesarean and no other deliveries. The rates of cesarean delivery and symptomatic uterine rupture for women with infants weighing > 4000 g were compared to the rates for women with infants weighing < or = 4000 g. Logistic regression was used to control for the potential confounding by use of epidural, maternal age, labor induction, labor augmentation, indication for previous cesarean, type of uterine hysterotomy, year of delivery, receiving public assistance, and maternal race. Adjusted odds ratios and 95% confidence intervals were calculated. RESULTS: Of 2749 women, 13% (365) had infants with birth weights > 4000 g. Cesarean delivery rate associated with birth weights < or = 4000 g was 29% versus 40% for those with birth weights > 4000 g (P = .001). With use of logistic regression, we found that birth weight > 4000 g was associated with a 1.7-fold increase in risk of cesarean delivery (95% CI, 1.3-2.2). The rate of uterine rupture for women with infants weighing < or = 4000 g was 1.0% versus a 1.6% rate for those with infants weighing > 4000 g (P = .24). Although the logistic regression analysis revealed a somewhat higher rate of uterine rupture associated with birth weights of > 4000 g (adjusted OR, 1.6; 95% CI, 0.7-4.1), this difference was not statistically significant. The rate of uterine rupture was 2.4% for women with infants weighing > 4250 g, but this rate did not differ significantly from the rate of uterine rupture associated with birth weights < or = 4250 g (P = .1). CONCLUSION: A trial of labor after previous cesarean delivery may be a reasonable clinical option for pregnant women with suspected birth weights of > 4000 g (8lbs, 13oz), given that the rate of uterine rupture associated with these weights does not appear to be substantially increased when compared to lower birth weights. However, some caution may apply when considering a trial of labor in women with infants weighing > 4250 g (9lbs, 6oz). In these women with infants weighing > 4000 g, the likelihood of successful vaginal delivery, although lower than for neonates weighing < or = 4000 g, is still 60%. |
VBAC vs. Repeat Cesarean Common causes of maternal death today are hemorrhage, infection, post-operative blood clots and adverse reactions to anesthesia. What to do if your hospital/doctor won't do a VBAC on you |
Midwifery Today, Issue 78 (Summer 2006)
Barbara Stratton of ICAN of Baltimore tells
women how to protest a VBAC denial.
Barbara Stratton of ICAN of Baltimore tells
women how to protest a VBAC denial.
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