VBA2C…Is it a good idea?

So we know that ACOG has said that VBACs are safe and appropriate for most women. Awesome!!

But what about VBA2C? If you ask most OBGYNs, you will probably get some raised eyebrows and a firm, “No!” Are you ready to arm yourself with some facts? Big thanks to Jen Kamel, founder of  www.vbacfacts.com , for sharing this helpful information!VBACInfo

Facts To Consider

1. What kind of scars do you have? You can confirm this via your operative report. Remember that the scar on your abdomen may be different than the scar on your uterus. The most common scar type is low transverse or horizontal, also called a bikini cut. Low transverse is associated with the lowest rate of uterine rupture.
2. Reasons for your cesareans? Women who have their cesareans for malpresentation (breech, transverse lie, ear/arm presentation, etc) and women who have had a prior vaginal delivery have the highest VBAC rates of over 80%.
3. What is your current health, in general and specific to this pregnancy?

Overview

“We don’t have a solid understanding of VBA2C risks. Several studies have been done. However, they don’t include enough women (need at least 3,000 – 4,000 and most include 1,000 or less) in order to accurately capture the rate of Uterine Rupture. Second problem is that many of these studies induce a large % of the labors. So when we have 1000 VBA2C women, and 50% of them are induced or augmented, it’s hard to determine which ruptures occurred due to the 2 cesareans, which occurred due to induction or if the final rate reported is inflated/to small because of inadequate sample population. It’s likely the risk increases. We just don’t have a good answer for how much. But ACOG says that some VBA2C women are candidates (2 low transverse scars would have the lowest UR rate) because of the increasing risks that come with multiple cesareans.” -Jen Kamel

Resources

“1. ACOG says VBA2C is reasonable in “some women” though evidence is limited. Having two prior low transverse cesareans is ideal as those scars are associated with the lowest level of rupture: http://vbacfacts.com/…/acog-issues-less-restrictive…/

2. If you plan on more children, a VBAC is mostly likely the safest choice in the long term: http://vbacfacts.com/…/why-cesareans-are-a-big-deal-to…/

3. Evidence strength on VBA2C is low because the studies conducted have included relatively few women (around a 1,000 or less) and don’t control for augmentation and induction. An excellent, though growing outdated, review of the literature can be found here: http://www.plus-size-pregnancy.org/…/vbac_after_2_cs.htm

4. I believe the 2010 NIH VBAC Conference discussed VBA2C: http://vbacfacts.com/…/best-compilation-of-vbac…/

5. Ways women have responded to VBAC bans: http://vbacfacts.com/…/mom-encounters-vbac-ban-request…/

6. My class is 6 hours and reviews all this and much more: http://vbacfacts.com/classes. I offer a online webinar in addition to a video.

I haven’t read the full text of this study: Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections.

Authors Tahseen S, et al. Show all Journal
BJOG. 2010 Jan;117(1):5-19. doi: 10.1111/j.1471-0528.2009.02351.x.

Affiliation
Leeds University Hospitals NHS Trust, Leeds, UK. stjavaid@yahoo.co.uk

Comment in
BJOG. 2010 Oct;117(11):1426-7; author reply 1427-8.
MAIN RESULTS: VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel-Haenszel).

“Whether you choose a VBAC or a repeat cesarean, the risks are elevated depending on how many prior cesareans you had.” – Jen Kamel

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