Many of my pregnant patients ask about the cesarean section rate at our practice. Everyone has heard in the media about the staggering number of cesarean births in the United States. It is true; the c-section rate in our nation has increased dramatically in the past 40 years from 5% in 1970 to 32.3% in 2008. There are many factors behind this increase – more infertility treatments (leading to more twins and triplets), a population that has more medical problems (obesity, increased maternal age, diabetes, high blood pressure), decreased use of forceps, and no longer delivering breech babies vaginally. Another reason for the increase in c-sections is a decrease in the number of vaginal births after a prior cesarean section, or VBAC.
It used to be said that “once a cesarean, always a cesarean.” This was because the scar in the uterus made at the time of c-section was found to have a slight chance of opening during a subsequent labor. This could lead to bleeding, the need for an emergency repeat c-section, and, in rare cases, hysterectomy, maternal death, or fetal death. Given the severity of these rare complications, many hospitals and doctors stopped offering VBAC as an option. The rate of VBAC deliveries decreased from 28% to 8.5% between 1996 and 2006.
However, as more studies have been done, we have learned a lot about the risks and benefits of VBAC compared to repeat c-section. We have also learned a lot about how to safely care for women who want a VBAC and what conditions give a woman a higher chance of having a successful VBAC. While both VBAC and repeat c-section carry risks, VBAC is associated with less risks to the mom and less risk of complications in future pregnancies. Many people don’t realize that 60-80% of women who attempt a VBAC are successful.
Factors that increase the chance of a successful VBAC include having had a prior vaginal birth and going into labor naturally (not being induced). Factors associated with a decreased chance of a successful VBAC include maternal obesity, increased weight of the baby, older moms, induction of labor, going past your due date, and having a prior c-section due to failure to dilate or inability to push the baby out.
Patients who have had a c-section and are pregnant or planning to become pregnant should have an open discussion with their doctor or midwife about the risks and benefits of VBAC versus repeat c-section for their current and/or future pregnancies. In most situations, women ultimately have the choice of attempting VBAC or scheduling a repeat c-section.
While reducing the rate of first time c-sections will have the greatest impact on our country’s overall c-section rate, optimizing the rate of VBAC deliveries is also important. Ultimately, this could decrease childbirth complications associated with cesarean delivery, such as excessive bleeding, injury to other organs during the surgery, infection, and problems with how the placenta implants in a future pregnancy.
Sources: VBAC Summit (Image)
For more information on VBAC:
- Vaginal Birth After Cesarean Delivery, by the American College of Obstetricians and Gynecologists