myths vs facts: home VBAC

Posted by: Sarah Trost in Uncategorized Add comments

Free Pictures | acobox.com“The well-known Landon (10) and Bujold (11) studies, which failed to control for induction of labor and may have had selection bias, also both showed a connection between induction and uterine rupture risk.

When I spoke with Dr. Landon at the 2007 ICAN conference he freely admitted this connection and had even addressed it in a further study on VBAC after multiple cesareans, which was published in 2006.(12) In an e-mail communication, Dr. Bujold also agreed that induction of labor was found to increase the uterine rupture rate.(13) My conclusion: Avoid induction and you remove a major part of the risk.”

Which is what I have found in my rupture support group. Nearly all of them were induced and almost all of them, of course, were in hospitals when they ruptured.

” In women with lower transverse uterine incisions who are not induced, the chances of uterine rupture range from 0.2% to 0.5%… The Lieberman birth center study of VBAC (2004) showed that the combined uterine rupture and fetal/neonatal death rate among women with a single previous c-section and who were less than 42 weeks was 0.2%.(16) That study also found that “half the uterine ruptures and 57% of perinatal deaths involved the 10% of women who had had more than one previous cesarean delivery and no previous vaginal births, or who had reached a gestational age of 42 weeks+.”(17)”

This proves how extremely important it is that the VBAC studies specify wither the mother was induced and what induction methods were used. If nearly all of the ruptures are because of induction and the remainder from VBAMC, it’s a terrible shame that these facts affect the ability of a woman to have a vaginal delivery after one cesarean, particularly with a prior vaginal birth, who has not been induced. Her chances of rupture are almost nothing, perhaps even less then the chance of a non scarred uterus of rupturing during a typical induction. Yet, women are induced all the time and women who desire a VBAC are turned away by the very same doctors.

And in the end, a possible 1% rupture rate of a VBAMC with no induction is still the same stat as many other birth risks, such as placental abruption which almost always causes fetal demise.

http://www.midwiferytoday.com/articles/homebirthaftercesarean.asp

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