A vaginal birth after a C-section delivery (VBAC) is the vaginal delivery of a baby by a mother who has previously given birth via C-section. Due to the high rate of maternal injury and fetal hypoxia (oxygen deprivation) associated with VBAC, the medical standard for many years was that once a mother had a C-section delivery, all deliveries thereafter had to also be done by C-section. In the last few years, however, the American College of Obstetrics and Gynecology (ACOG) has begun to recommend VBAC, but only in low-risk cases in which patients are carefully chosen and adequately informed of the risks and benefits of the procedure. Approximately 80% of that small, select, low risk group of women are likely to have a successful VBAC.
Risks Associated with VBAC Deliveries
A VBAC can be very risky for the mother and baby because it increases the likelihood of one of the most serious complications of labor and delivery, which is uterine rupture. When the uterus (womb) ruptures, the baby’s oxygen supply can be severely decreased (hypoxia) or completely cut off, and the baby may move out of the womb and into the mother’s abdomen. In addition, bleeding caused by the rupture can be life threatening for the mother and baby. When a rupture occurs, the baby must be delivered immediately by an emergency C-section in order to minimize the injury that can occur as a result of severe hypoxia. Hypoxia and asphyxia can cause hypoxic-ischemic encephalopathy (HIE), which often leads to permanent brain damage in a baby, including cerebral palsy, seizure disorders, and intellectual and developmental disabilities. In severe cases of uterine rupture, the mother may need to undergo a hysterectomy.
Planning for Vaginal Birth After a C-Section Delivery
There are certain conditions that increase the likelihood that a VBAC will be successful. These may include the following:
- The mother has a low transverse uterine scar as opposed to a vertical scar (or scars). Currently, most C-section scars are the low transverse type.
- The mother had a previous vaginal delivery, either before or after the prior C-section
- There was not a single layer closure in a prior C-section
- There is no use of labor induction drugs, such as Pitocin. Risk of uterine rupture is further increased when multiple labor induction drugs are used together, such as Pitocin with Cytotec.
- The baby is not macrosomic (large) or large for gestational age
- The baby is in a normal presentation (head first) and not in an abnormal position, such as face or breech presentation
- The mother is pregnant with only one baby (no twins, triplets, etc.)
- The mother is not obese
- The mother is younger than 35 years of age
- It has been longer than 14 months since the mother’s last C-section
- The mother does not have a history of failure to tolerate labor that includes fetal distress
- During delivery, no labor dystocia (difficult labor) is present, especially at advanced gestational age
- The mother had a good Bishop score on admission to Labor and Delivery. Bishop score is a scoring system used to help predict whether induction of labor will be required.
- The mother did not have a previous uterine rupture
- Certain obstetrical maneuvers are not used during labor and delivery. These maneuvers include internal version (physician’s adjustment of baby’s position in the uterus by placing one hand in the mother’s vagina and the other on her abdomen), extraction of a baby in breech presentation, and use of vacuum extractors and forceps.
- On imaging, an intact, thick scar is reassuring of the integrity of the repair of the prior C-section, and a thin scar or defect is worrisome for a uterine rupture during labor.
Even without uterine rupture, there is an increased risk of HIE with VBAC, according to several studies. One large study found an increased incidence of HIE in women who had a trial of labor after C-section, compared to zero cases of HIE in women who underwent an elective repeat C-section delivery.
The risks of VBAC are very serious, including the risk of the devastating condition of a ruptured uterus. It therefore is crucial that the mother and physician have an in-depth discussion about the mother’s chances of having a uterine rupture or other complications during the VBAC. This means that it is crucial for the physician to take a thorough history from the mother.
Legal Help for VBAC Injury Victims
The award-winning birth trauma lawyers at Reiter & Walsh ABC Law Centers have decades of experience in birth injury, uterine rupture, hypoxic-ischemic encephalopathy and VBAC cases. If your physician did not thoroughly discuss the risks and benefits of VBAC, or if you experienced complications during a VBAC and your child developed an injury such as HIE, we can help you. Our skilled attorneys will work tirelessly to get you the compensation you and your family deserve, and you never pay any money until we win your case.
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