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Trusting Our Bodies
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Husband-Coached Childbirth® directly, please contact: The Bradley Method®, Box 5224 Sherman Oaks, CA 91413-5224, 1-800-4-A-BIRTH
or 1-818-788-6662, www.bradleybirth.com
| Women who normally go beyond 40 weeks of pregnancy before naturally going into labor can safely have a VBAC! Obstetrics and Gynecology 2005 Oct;106(4):700-6. Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. Coassolo KM, Stamilio DM, Pare E, Peipert JF, Stevens E, Nelson DB, Macones GA. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. kcoassolo@obgyn.upenn.edu OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate. RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased. CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased. |
| A woman who has a VBA2C is only slightly more at risk for major complications than a woman who has a vaginal birth after only one cesarean. Also, VBA2C women are also slightly more at risk for major complications than women who elect repeat cesarean after two cesareans. However, the risk of major complications for VBA2C is still very low. American Journal of Obstetrics & Gynecology 2005 Apr;192(4):1223-8 Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option? Macones GA, Cahill A, Pare E, Stamilio DM, Ratcliffe S, Stevens E, Sammel M, Peipert J. Departments of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA. gmacones@mail.obgyn.upenn.edu OBJECTIVE: This study was undertaken to compare clinical outcomes in women with 1 versus 2 prior cesarean deliveries who attempt vaginal birth after cesarean delivery (VBAC) and also to compare clinical outcomes of women with 2 prior cesarean deliveries who attempt VBAC or opt for a repeat cesarean delivery. STUDY DESIGN: We performed a secondary analysis of a retrospective cohort study, in which the medical records of more than 25,000 women with a prior cesarean delivery from 16 community and tertiary care hospitals were reviewed by trained nurse abstractors. Information on demographics, obstetric history, medical and social history, and the outcomes of the index pregnancy was obtained. Comparisons of obstetric outcomes were made between women with 1 versus 2 prior cesarean deliveries, and also between women with 2 prior cesarean deliveries who opt for VBAC attempt versus elective repeat cesarean delivery. Both bivariate and multivariate techniques were used for these comparisons. RESULTS: The records of 20,175 women with one previous cesarean section and 3,970 with 2 prior cesarean sections were reviewed. The rate of VBAC success was similar in women with a single prior cesarean delivery (75.5%) compared with those with 2 prior cesarean deliveries (74.6%), though the odds of major morbidity were higher in those with 2 prior cesarean deliveries (adjusted odd ratio[OR] = 1.61 95% CI 1.11-2.33). Among women with 2 prior cesarean deliveries, those who opt for a VBAC attempt had higher odds of major complications compared with those who opt for elective repeat cesarean delivery (adjusted OR = 2.26, 95% CI 1.17-4.37). CONCLUSION: The likelihood of major complications is higher with a VBAC attempt in women with 2 prior cesarean deliveries compared with those with a single prior cesarean delivery. In women with 2 prior cesarean deliveries, while major complications are increased in those who attempt VBAC relative to elective repeat cesarean delivery, the absolute risk of major complications remains low. |
| Obstetricians should make it clear when informing their patients that VBAC is safer than an elected repeat cesarean! American Journal of Obstetrics & Gynecology 2006 Oct;195(4):1143-7 Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery? Cahill AG, Stamilio DM, Odibo AO, Peipert JF, Ratcliffe SJ, Stevens EJ, Sammel MD, Macones GA. Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, USA. OBJECTIVE: This study was undertaken to determine whether vaginal birth after cesarean (VBAC) or elective repeat cesarean delivery is safer overall for a woman with a prior vaginal delivery. STUDY DESIGN: This retrospective cohort study of pregnant women from 1996 to 2000 who had a prior cesarean delivery, was conducted in 17 centers. Trained nurses extracted historical and maternal outcome data on subjects by using standardized tools. This planned secondary analysis examined the subcohort that had also previously undergone a vaginal delivery, comparing those who underwent a VBAC trial with those who elected to have a repeat cesarean delivery. Outcomes included uterine rupture, bladder injury, fever, transfusion and a composite (uterine rupture, bladder injury, and artery laceration). We performed bivariate and multivariable analyses. RESULTS: Of 6619 patients with a prior cesarean delivery who had also had a prior vaginal delivery, 5041 patients attempted a VBAC delivery and 1578 had an elective cesarean delivery. Although there was no significant difference in uterine rupture or bladder injury between the two groups, women who underwent a VBAC attempt were less likely to experience the composite adverse maternal outcome, have a fever, or require a transfusion. CONCLUSION: Among VBAC candidates who have had a prior vaginal delivery, those who attempt a VBAC trial have decreased risk for overall major maternal morbidities, as well as maternal fever and transfusion requirement compared with women who elect repeat cesarean delivery. Physicians should make this more favorable benefit-risk ratio explicit when counseling this patient subpopulation on a trial of labor. |
| Vaginal Birth After Cesarean |
| It is safe for women who gave birth to twins via cesarean to have a VBAC with her next pregnancy! Women who gave birth to twins via cesarean and want to attempt a VBAC are no more likely to have their VBAC result in a cesarean, experience uterine rupture or experience a major maternal morbidity than a woman attempting a VBAC after a singleton pregnancy resulted in a cesarean. American Journal of Obstetrics & Gynecology 2005 Sep;193(3 Pt 2):1050-5 Vaginal birth after cesarean (VBAC) attempt in twin pregnancies: is it safe? Cahill A, Stamilio DM, Pare E, Peipert JP, Stevens EJ, Nelson DB, Macones GA. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, USA. acahill@mail.obgyn.upenn.edu OBJECTIVE: The purpose of this study was to compare the rate of vaginal birth after cesarean (VBAC) attempt, VBAC failure, and major maternal adverse outcomes in women with a previous cesarean with twin or singleton pregnancies. STUDY DESIGN: This was a multicenter retrospective cohort study between the years 1996 and 2000. Subjects were identified by ICD-9 code. Trained research nurses collected medical record data on the outcome of VBAC attempts, and clinical outcomes, including uterine rupture and major operative injuries. We used bivariate and multivariable techniques to assess the association between twins and the outcomes. RESULTS: Of 25,005 patients with at least 1 previous cesarean, there were 535 twin pregnancies and 24,307 singleton pregnancies. Compared with patients with singleton gestations, patients with twins were less likely to attempt a VBAC (adjusted odds ratio [AOR] 0.3, 95% CI 0.2-0.4), but no more likely to have a VBAC failure (AOR 1.1, 95% CI 0.8-1.6), a uterine rupture (AOR 1.2, 95% CI 0.3-4.6), or a major maternal morbidity (AOR 1.6, 95% CI 0.7-3.7). CONCLUSION: Women with twin gestations are less likely to attempt a VBAC, but they are no more likely to fail a VBAC trial or experience a major morbid event compared with women with singleton gestations. |
| You can successfully VBAC with a baby suspected of being 8lbs, 13oz in weight or more! Babies over 9lbs, 6oz can still be born vaginally after cesarean with a 60% success rate! Outcomes of trial of labor following previous cesarean delivery among women with fetuses weighing >4000 g (8lbs, 13oz). Zelop CM, Shipp TD, Repke JT, Cohen A, Lieberman E. Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA. OBJECTIVE: To compare outcomes at term of a trial of labor in women with previous cesarean delivery who delivered neonates weighing > 4000 g versus women with those weighing < or = 4000 g. STUDY DESIGN: We reviewed medical records for all women undergoing a trial of labor after prior cesarean delivery during a 12-year period. The current analysis was limited to women at term with one prior cesarean and no other deliveries. The rates of cesarean delivery and symptomatic uterine rupture for women with infants weighing > 4000 g were compared to the rates for women with infants weighing < or = 4000 g. Logistic regression was used to control for the potential confounding by use of epidural, maternal age, labor induction, labor augmentation, indication for previous cesarean, type of uterine hysterotomy, year of delivery, receiving public assistance, and maternal race. Adjusted odds ratios and 95% confidence intervals were calculated. RESULTS: Of 2749 women, 13% (365) had infants with birth weights > 4000 g. Cesarean delivery rate associated with birth weights < or = 4000 g was 29% versus 40% for those with birth weights > 4000 g (P = .001). With use of logistic regression, we found that birth weight > 4000 g was associated with a 1.7-fold increase in risk of cesarean delivery (95% CI, 1.3-2.2). The rate of uterine rupture for women with infants weighing < or = 4000 g was 1.0% versus a 1.6% rate for those with infants weighing > 4000 g (P = .24). Although the logistic regression analysis revealed a somewhat higher rate of uterine rupture associated with birth weights of > 4000 g (adjusted OR, 1.6; 95% CI, 0.7-4.1), this difference was not statistically significant. The rate of uterine rupture was 2.4% for women with infants weighing > 4250 g, but this rate did not differ significantly from the rate of uterine rupture associated with birth weights < or = 4250 g (P = .1). CONCLUSION: A trial of labor after previous cesarean delivery may be a reasonable clinical option for pregnant women with suspected birth weights of > 4000 g (8lbs, 13oz), given that the rate of uterine rupture associated with these weights does not appear to be substantially increased when compared to lower birth weights. However, some caution may apply when considering a trial of labor in women with infants weighing > 4250 g (9lbs, 6oz). In these women with infants weighing > 4000 g, the likelihood of successful vaginal delivery, although lower than for neonates weighing < or = 4000 g, is still 60%. |
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VBAC Safety Below is the most updated research on the safety of VBAC:
Scroll down to read the research for yourself and check out more extensive research on VBAC at www.VBACFacts.com |
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