VBAC (Vaginal Birth After Cesarean) and Informed Consent

What is a VBAC?

A VBAC (Vaginal Birth After Cesarean) is the vaginal birth of a child after a mother has undergone one or more cesarean deliveries (C-sections). For many years, doctors believed that if a woman had one cesarean delivery, all other babies she had should be born in the same way. Today, however, doctors know that many women who have had a C-section are able to deliver vaginally in subsequent pregnancies.

Statistics show that over the last 10 years, about 10 to 20% of women with a prior cesarean section have attempted VBAC. Of the women who tried, 60-80% succeeded and gave birth vaginally.

VBAC Safety

While a VBAC delivery can be a safe option for some women, it is not the right choice for many others. Whether VBAC is a good choice depends on many factors, including risks. The biggest risk with VBAC is uterine rupture. This is where the cesarean scar ruptures or tears during labor and delivery. A rupture is an obstetrical emergency and generally requires an emergency C-section to deliver the baby quickly. VBAC should not be tried if there is a high risk of rupture.  Another risk of VBAC is hypoxic ischemic encephalopathy (birth asphyxia). This is when oxygen to the baby is diminished or cut off. Other risks of VBAC include infection and C-section (in about 25% of VBAC attempts, the baby must be delivered by C-section anyway).

There are also additional factors that decrease the chance of a successful VBAC. Some of these include morbid obesity in the mother, a short interval between the prior cesarean and the VBAC (less than 18 to 24 months), a single layer closure for the first cesarean section, a vertical incision for the cesarean section rather than a horizontal/transverse incision, a large baby, and maternal medical problems (e.g. diabetes, high blood pressure).

Informed Consent in VBAC

Regardless of the type of treatment or procedure being performed, it is always a healthcare professional’s responsibility to adequately inform a patient. This means letting a patient know:

  • Who will perform the procedure and his or her qualifications
  • What the patient’s medical condition is
  • The purpose of the proposed procedure
  • The risks involved
  • Any alternative treatments or procedures and the risks of those
  • The chances of the procedure’s success
  • The expected recovery time

Patients considering VBAC should be informed of all the risks and alternatives (C-section) before labor and delivery. This allows mothers to make good, educated decisions about whether to go ahead with a VBAC birth plan and to understand the potential conditions where a C-section may become necessary during labor and delivery. And most importantly, if multiple risk factors exist, the practitioner is obligated to make the mother aware of them and inform her that she is not a good candidate for VBAC.

If a patient has not been adequately informed and the mother or baby is injured during a VBAC or attempted VBAC, there may be grounds for a medical malpractice case. If you have been in a similar situation, you should speak to an attorney as soon as possible. Reiter & Walsh ABC Law Centers are birth injury attorneys who focus exclusively on birth injury cases. Call us toll-free at 888-419-2229 to discuss your case. The initial consultation if free and we never charge any fees until we win your case.

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