I am asked about Cesarean section and VBAC ( vaginal birth after cesarean ) more and more as the statistics for obstetrical surgery increase in our country. There are some every good reasons for primary C-sections and also reasons for a repeat with another pregnancy. If the baby is breech, if there are complicating medical factors, if there is a disproportion between the baby's head and the mother's pelvis, if labor doesn't progress over time, if there is a sudden fetal event, if the fetus is compromised by some anomaly in utero and the list for good reasons goes on.
However, there are many women who would like to try a trial of labor after Cesarean section for equally good reasons. If there is already a child at home, it is much easier to get back "into the swing of things" if you aren't recovering from major abdominal surgery. In fact, if you don't have to, many women just don't want the inherent increased risks of abdominal surgery: infection, hemorrhage, even the need for much more post delivery pain medications.
There is a study published in the September issue of Obstetrics and Gynecology from Denver Health Medical Center and Dr. Torri Metz and colleagues that provides a model for predicting successful trial of labor and subsequent vaginal delivery after Cesarean section. The study was large using almost 5,000 women who were delivering immediately after a primary C-section and who were now delivering only a singleton. One fifth of the women underwent trial of labor and eighty percent were successful.
Variables were used that were associated with vaginal birth success after primary C-section. A history of vaginal birth, absence of recurrent indication for primary C-section, maternal age under thirthy-five, BMI less than 30 ( body mass index ) and each point of the Bishop score ( cervical progression indicator ) were used to predict outcome at admission to labor and delivery at the hospital. Total scores more then 16 had a more than 85% success rate for VBAC and women with a score of less than 10 had a less than 50% success rate.
The significance of this study is for physicians to keep an open mind when counseling their patients. The decision to modify the trial of labor can be initiated at any time, due to circumstance,s however, this provides concrete evidence that women should not be discouraged about approaching the topic of VBAC with their provider. As the chances for success increase, women should be encouraged to try a trial of labor since morbidities associated with successful VBAC are less than that of a scheduled Cesarean section.
It is always a collaborative effort and relationship between physicians and their patients. Do not be intimidated about asking questions and receiving adequate answers. We always must be our own advocates as medical consumers, recognizing that our physicians have the knowledge and expertise to guide us wisely toward making our own decisions.