Birth Myths - VBACs and uterine rupture
Australia’s caesarean section (c-section) rate is high. It is triple the World Health Organisation’s ‘recommended’ rate, in fact.
One third of Australia’s birthing women birth their babies via c-section, according to the AIHW’s Australia’s mothers and babies Report 2016.
45% of first time mothers who experience an induced labour go on to birth their babies via c-section.
Out of all women who birth via c-section 86% go on to birth subsequent babies via c-section also. The percentage of women going on to have normal vaginal births after a previous c-section is just 14%.
Vaginal births after c-sections are possible!
The fact that one woman has delivered via c-section previously is not reason enough to state that she will never be able to achieve a vaginal birth. Of course, with health complications and pregnancy complications this is the case for some, but it is not the previous c-section which is the determining factor.
Yet, only 14% of women who have had previous c-sections, go on to deliver vaginally.
Statistically, most vaginal births after c-sections (VBAC) are safe. More than 70% of VBACs are successful. Certainly, there are times where a VBAC would not be recommended but for those that are possible, the success rate is pretty high. This throws the ‘you’ve had 1 c section so now you can only have c-sections’ excuse that is quite often used, right out the window. We wouldn’t have a 70% success rate of VBACs if this was a valid reason.
This beautifully written article by Hannah Dahlen, one of Australia’s most well-known midwives, also a Professor of Midwifery at Western Sydney University, explored VBACs in depth and gave an excellent overview of what drives women’s decisions on whether or not to pursue a VBAC.
The article states that upon looking into motivating factors for women in choosing or not choosing VBACs, that women either had the perspective that a ‘good parent sacrifices themselves for their baby and takes no risks’ or that ‘giving birth matters to the woman and a happy, healthy mother is a happy healthy baby’.
The women that put the needs of their babies above themselves were more likely to choose a repeat c-section.
Mothers who are provided with evidence based care and support for their choice in pursuing a VBAC are more likely to succeed in this pursuit.
Unfortunately, in Australia’s medical system there is a rife lack of support for VBACs and finding the right health care professional, or indeed even hospital, can be tricky.
Advice based out of fear is the most common trend I see amongst women seeking VBACs. Of course there are risks with VBACs but nothing we do in life is risk-free, so it is important to educate yourself on the REAL risks and just what that means for you.
The biggest thing to consider is the reason why you had a c-section initially; as this directly affects the risks associated with attempting a VBAC.
For instance, a c-section which was performed due to placenta previa in a prior birth does not denote that a c-section will automatically be required for all subsequent births.
One of the most common ‘reasons’ that are given for VBACs being denied by health care providers is the risk of uterine rupture.
Uterine rupture is a rare but a potentially serious complication for both Mum and bub. A uterine scar rupture is where the mother’s uterine wall separates along or near the scar line from her previous c-section, potentially causing severe bleeding.
Uterine rupture is a real risk, yes, but it’s not as risky as you might be led to believe.
The type of c-section you received initially has a lot to do with the risk of uterine rupture in this case.
Typically, women either receive a ‘lower segment caesarean section’ (LSCS) (most common) or a ‘classical caesarean section’. The difference being that, an LSCS involves a horizontal incision along the lower part of the woman’s uterus, and a classical c-section is where the incision is made vertically through the uterus. Classical c-sections are now mostly only performed in emergency situations where quick access to the baby is required.
Classical c sections do pose a greater risk of uterine rupture in future births due to the nature of the incision.
So what are the actual risks…
An Australian studied published in 2010 found that the risk of uterine rupture among women who went into spontaneous labour was 0.15%. Less than quarter of a percent!!! Women are being scared and bullied into consecutive c-sections for a risk of 0.15%!!! Seriously!
The study also found that women who were induced with the use of oxytocin had a risk of 1.91%! This means that, for these women, their risk of uterine rupture increased 14-fold…at the hands of medical intervention which is marketed to ‘save’ and ‘help’ women achieve shorter more effective labours…
In fact, these statistics show that you are more likely to have a prolapsed umbilical cord (considered a rare risk in and of itself) during your labour over the risk of a uterine rupture. There is a 0.2%-0.4% chance of you having a prolapsed umbilical cord compared with the 0.15% of uterine rupture for VBAC births.
Just to really drive this home for you; VBACs and the risk of uterine rupture are almost a complete non-issue when compared to the statistics for maternal outcomes for Aboriginal and Torres Strait Islander Women who die at THREE TIMES the rate for other Australian women.
If you are driven towards a VBAC, the odds are in your favour. Of course seek medical advice first, but don’t be afraid to ask questions and go in armed with your own research. If your OB can’t tell you the real risks of why a VBAC isn’t possible for you, I would 100% be finding a new care provider or at least seeking a second and third opinion.
Research what the c-section rate for your chosen hospital or care provider is – ask questions and seek answers.
All of the statistics I have mentioned here are easily found online and readily available.
It is a sad fact in today’s medicalised maternal system that you need to fight, sometimes tooth and nail, for the birth that you want. But clearly, as I’ve demonstrated here, the benefits far outweigh the risks.