Wednesday, 14 March 2012

Is a Planned Repeat C-section Safer Than a VBAC?

Yes yes I know I said I was on holiday, but having a look at the BBC news I just came across this article and couldn't keep myself from commenting....

The quick summary is that two studies, one in the UK and one in Australia have been published which show that women who chose a repeat C-section over a VBAC (vaginal birth after Cesarean) have better outcomes. There were fewer cases of still birth and uterine rupture (very dangerous, potentially fatal complication that is more common after a previous Cesarean) in the C-section groups than the VBAC groups, although in both groups the risks of either were very very small.

The papers were published in PLoS Medicine and are open access for a change so you can have a look at them yourself (here and  here ) or read a nice perspective article on them here. This article is also interesting in how it suggests these studies will affect medical practice. It is written from an American point of view where the Cesarean rate is far higher than in the UK and where many hospitals just don't allow a VBAC because of the tiny risk of uterine rupture. This is very different to the UK where the majority of obstetricians and midwives advocate VBAC.

Having had an emergency C-section with E, I was told by a consultant obstetrician at the hospital that a VBAC would be the expected route for any future delivery and that elective cesareans were possible only if the mother could argue her case on mental health grounds with the departments own psychiatrist. Not exactly free choice.

Currently there is no solid evidence that either the UK or US model is better. Which begs the question - if both C-sections and VBACs carry very little risk why are women often pushed (if you'll excuse the pun) down one route or the other?

Is it assumed that pregnant women are too befuddled by hormones and what they've seen on One Born Every Minute to make a reasoned decision for themselves? Left to our own devises would every British women opt for major, debilitating surgery over trying to experience natural childbirth? Would every American Mom prefer to risk death by uterine rupture so she could birth her child with only the aid of homoeopathic remedies and an aromatherapy candle?

Of course not, we're grown women, we're not stupid - can we just have the facts and make the choice about our own bodies now please?

I'd be really interested to hear other people's opinions and experiences on this, please comment below.

3 comments:

  1. In Argentina it is like in the US...you are seriously advice to have a cesarean after a first C section...but then again, I think Arg has the higher rates of C sections...doctors are afraid of any risk, and C section is their first option in all cases..I don´t know if I am influenced by the environment, but I´d go for a C section if I have a second one, since O was born that way, I would sign something taking responsability if I´d choose VBAC..

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  2. Really interesting how different it is, there can't possibly be a physical reason for VBAC being safer this side of the Atlantic! I wonder how much influence economics (NHS cost savings v fear of litigation in the US) and UK groups which advocate natural birth such as the NCT and Royal college of midwives have over this? The fact UK maternity units are also ranked by factors including their C-section rate could also be significant.

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  3. Just found this blog by an American Ob/Gynae: The effect of malpractice claims on c-sections. It’s worse than you think

    http://drjengunter.wordpress.com/2011/08/10/malpractice-claims-and-csections/

    goes along with my influence of economics theory!

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