VBAC (Vaginal Birth After C-Section) Delivery and Birth Injury
Vaginal births after Cesarean section delivery (VBACs) increase the risk of serious health complications and emergencies such as uterine rupture (where previous C-Section scars tear and expel the baby and placenta into the abdomen). While uncommon, uterine rupture causes severe blood loss, birth injuries, hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Because of the severity of uterine rupture, emergency C-Sections must be performed within 2-15 minutes of the rupture. This occurs most commonly when labor induction drugs are used, when the mother is 35+, and when the mother has had multiple C-Sections prior to delivery.
A VBAC (vaginal birth after C-section) delivery is the vaginal delivery of a baby by a woman who previously had a C-section. About 60-80% of women who have had prior C-sections can successfully deliver a baby vaginally with their future pregnancies. Despite this high rate of success, however, there are still obstetrical situations in which VBACs are very dangerous and inadvisable. In recent years, VBACs have been attempted on fewer than 20% of women who have had prior C-sections. Due to the serious risk of uterine rupture with a VBAC, the American College of Obstetrics and Gynecology (ACOG) only recommends VBAC in very lo- risk cases where patients are carefully chosen and given informed consent.
Risks, Complications and Birth Injuries Associated with VBAC Delivery
Uterine Rupture and Vaginal Birth After C-Section Delivery
The most serious risk associated with vaginal birth after C-section deliveries is uterine rupture. This occurs when the scar from the previous C-section tears open during labor and delivery. Uterine rupture typically results in expulsion of the baby and the placenta into the mother’s abdomen. When this occurs, there often is hemorrhaging (rapid, uncontrolled bleeding) that can cause the baby to be severely deprived of oxygen (hypoxia). This can lead to permanent brain damage from hypoxic ischemic encephalopathy (HIE) resulting in developmental delays and cerebral palsy.
While the risk for uterine rupture appears low statistically (estimated between about 0.5% and 1.5% of all vaginal birth after C-section deliveries), the outcome can be devastating. Uterine rupture can cause severe blood loss, hysterectomy, birth injury, hypoxic ischemic encephalopathy (HIE), cerebral palsy or even infant death (about 1 in 20 of these ruptures results in fetal death).
When the uterus ruptures, medical professionals must act quickly. It is imperative that the hospital is equipped for immediate emergency C-section delivery and is able to deliver the baby with 10 to 15 minutes of the uterine rupture. This minimizes the chances of fetal oxygen deprivation and hypoxic ischemic encephalopathy (HIE).
Research shows that uterine rupture is more common in three instances—when labor induction drugs such as Pitocin or Cytotec are used, when the mother is over 35 years of age, and when the mother has had multiple C-sections. Medical professionals must consider these risk factors for VBAC and explain their dangers to the patient.
Infection and Vaginal Birth After C-Section Delivery
In cases where a vaginal birth after C-section delivery is attempted but a C-section ultimately needs to be performed, there is an increased risk of infection in both the mother and the baby.
Failed VBAC and Emergency C-Section Delivery
Approximately 25% of vaginal birth after C-section delivery attempts fail and a C-section is required anyway. Medical professionals must discuss the potential for an emergency C-section with the mother and obtain informed consent.
What Makes a Good VBAC Candidate?
There are certain conditions that doctors must take into consideration when determining whether a woman is an appropriate candidate for a vaginal birth after C-section delivery. Typically, the best candidates have:
- A low transverse uterine scar but no more than two low transverse cesarean deliveries. Low transverse uterine scars are low, U-shaped scars.
- A previous vaginal delivery either before or after the prior C-section
- At least 18-24 months since the last C-section
- No additional uterine scars, complications or previous ruptures
- The medical reason for the original cesarean delivery is not present with the current pregnancy
- No other major medical problems with the mother exist such as diabetes, obesity, high blood pressure or genital herpes
- A single baby (a single gestation, as opposed to twins, triplets or other multiples)
- The baby is in the correct position (vertex presentation) and is not macrosomic (a larger than average baby)
Types of C-section incisions:
As in any delivery, the baby should be monitored continuously and very carefully. If fetal distress signals are present and interventions (eg: amnio infusion, oxygen, etc.) aren’t successful, then a C-section should be performed as quickly as possible.
Medical Malpractice in VBAC Cases
Sometimes errors in judgment or practice by physicians and other medical staff can occur during a vaginal birth after C-section delivery. These can cause permanent and serious injury to the baby. Any medical mistake and deviation from care standards that results in injury to the mother or baby is considered medical malpractice.
Instances of medical malpractice in VBAC cases may include:
- Failure to inform the patient of risks involved with VBAC
- Allowing VBAC delivery for a patient who is a poor candidate
- Failure to abandon a VBAC attempt and properly and quickly perform a C-section when necessary
- Attempting a VBAC delivery in a hospital that is not equipped to handle emergency C-sections
- Failure to have in place and follow organizational policies and procedures for VBAC deliveries
- Failure to secure informed consent for an emergency C-section
- Failure to use fetal monitoring during VBAC
- Failure to respond adequately to changes in fetal monitoring
Legal Help for VBAC Injuries from Medical Malpractice
If you believe that your child has birth injuries as a result of negligence during a vaginal birth after C-section delivery or a failed VBAC attempt, we encourage you to contact Reiter & Walsh ABC Law Centers. Our Detroit, Michigan birth injury attorneys exclusively focus on birth injury cases, many of which include hypoxic ischemic encephalopathy (HIE) and infant brain damage. Our compassionate, focused and knowledgeable approach to birth injury cases has earned us the reputation of being one of the best medical malpractice firms in the country. From our main location in Detroit, Michigan, our team handles birth injury and VBAC cases all over the United States. We’re able to help clients and their families in Michigan, Ohio, Arkansas, Mississippi, Wisconsin, Pennsylvania, Washington D.C., Tennessee, Texas, and other parts of the United States.
To begin your free case review, please contact our birth injury attorneys in any of the following ways:
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VIDEO: VBAC Attorneys & HIE Lawyers discuss Birth Asphyxia & Birth Injuries
Watch a video of VBAC attorneys Jesse Reiter & Rebecca Walsh discussing birth asphyxia and how this can cause severe birth injuries.