13 Myths About Vaginal Birth After Cesarean | By Jennifer Kamel of VBACFacts.com
Many women believe that the only safe choice after a cesarean is another cesarean. Social pressure plays a huge role in a woman’s decision making process. The prevailing conventional wisdom in the United States is greatly influenced by persistent and pervasive myths about VBAC, or Vaginal Birth after Cesarean. The result is a 92% repeat cesarean rate in America, despite the fact that most women are candidates for a VBAC and most VBACs are successful. To make an informed choice about your birth, you need to know the myths and truths about VBAC.
MYTH: Once a cesarean, always a cesarean. According to the National Institutes of Health (NIH), “VBAC is a reasonable and safe choice for the majority of women with prior cesarean.” The American College of Obstetricians & Gynecologists (ACOG) concurred when they said “most” women with one prior cesarean and “some” women with two prior cesareans are candidates for VBAC.
MYTH: A VBAC after one cesarean has a 60-70% risk of uterine rupture. The risk of uterine rupture after one low transverse (bikini) cut cesarean is about 0.5% – 1% depending on various factors. First time moms delivering vaginally are at risk for complications that are equally serious to uterine rupture and occur at a similar rate such as placental abruption, cord prolapse, and shoulder dystocia. MYTH: Hospitals ban VBAC because it’s such a serious and unusual complication that they cannot manage it appropriately. Hospitals with labor and delivery units have protocols in place to respond to obstetrical emergencies. The guidelines used to manage the complications from first time moms and repeat cesarean moms are also used to address uterine rupture in VBAC moms.
MYTH: VBAC moms can’t have epidurals because it will obscure the pain of uterine rupture. Per ACOG, epidurals may be used in a VBAC and evidence suggests that epidurals do not mask uterine rupturerelated pain. However, only 26% of women who experience a uterine rupture report abdominal pain, so it is an inconsistent and unreliable symptom.
MYTH: There is a 25% chance that either baby or mom will die during a VBAC. The risk of maternal mortality is very low whether a woman plans a VBAC (0.0038%) or an elective repeat cesarean (0.0134%). Limited evidence suggests that there is a 2.8 – 6.2% risk of infant death after a rare uterine rupture.
MYTH: There are no risks associated with cesareans other than surgery. The most serious cesarean-related complications become more likely as an individual woman has more cesareans. These complications include placental abnormalities such as placenta accreta, which carries a 7% maternal mortality rate and a 71% hysterectomy rate. After two cesareans, the risk of accreta is 0.57%, simil