Safety of Vaginal Birth After CesareanInternational Cesarean Awareness Network
The International Cesarean Awareness Network (ICAN) affirms the safety of vaginal birth after a cesarean.
In a statement released July 6, 2001, the International Cesarean Awareness Network (ICAN) urged that a recent study should not cause women or their care providers to abandon vaginal birth after cesarean (VBAC). ICAN also reaffirmed that VBAC is still the safest choice for most women and babies when compared with the risks of elective repeat cesarean section.
The ICAN Board of Directors unanimously approved the following statement: "A new study in the New England Journal of Medicine adds important information to our ongoing knowledge about vaginal birth after cesarean and the risks of medical intervention. The study, which confirmed two decades of research about the relative safety of VBAC, has been widely reported as suggesting that the risk of uterine rupture during attempted VBAC has increased and that mothers should consider scheduling repeat cesarean section rather than planning for vaginal birth. In fact, the risk of rupture for women who begin labor spontaneously was shown to be 0.5%, lower than many other recent studies have shown and consistent with the body of medical literature on VBAC. Women planning VBAC should be encouraged that the risk of uterine rupture remains low when labor is allowed to start on its own.
However, the study also confirmed what ICAN has known for many years: that induction of labor in women planning VBAC increases the rate of uterine rupture significantly. Women and their care providers should not consider induction of labor in the presence of a previous cesarean scar without a thorough weighing of the potential risks and benefits. A trial of labor involving induction should occur in a hospital equipped to handle obstetric emergencies.
In any discussion about VBAC, women must also be provided with unbiased, evidence-based information about the known risks of elective cesarean section. Cesarean section, which can be a life-saving operation when necessary, carries immediate significant risks for both mother and baby and increases the risk of complications in subsequent pregnancies. Risks to the mother include excessive blood loss and transfusions, scarring, adhesions, injury to internal organs, infection, anesthesia complications, blood clots, decreased bowel function, and postpartum depression. Elective cesarean section increases a woman's risk of hysterectomy in both the current and future pregnancies, and doubles her risk of death compared to vaginal birth.
Babies delivered by elective cesarean section are cut during surgery 2-6% of the time, have a 9% chance of being born prematurely, and risk a 0.4% chance of developing respiratory distress syndrome, a potentially fatal complication. They spend more time in neonatal intensive care units and have more breastfeeding difficulties than babies born vaginally.
Cesareans also increase the risks to both mother and baby in subsequent pregnancies. Incidences of life-threatening placental abnormalities increase with each cesarean. When all short- and long-term consequences are considered, VBAC has been shown to be less risky for both mother and baby than elective repeat cesarean section.
Given that it is the previous cesarean which introduces the risk of uterine rupture into a woman's reproductive life, not VBAC, health care providers must heed the call to lower the primary cesarean rate while continuing to support women who choose VBAC. Fewer primary cesareans will result in fewer mothers and babies at unnecessary risk from uterine rupture. Access to VBAC ensures that women will not have to submit themselves and their babies to the risks of surgical delivery without medical need. Working on these goals simultaneously will help to improve the health and well-being of mothers and babies. Women have the right to experience birth safely, as nature intended, and babies deserve nothing less.ICAN is a nonprofit organization working to lower the rate of unnecessary cesarean sections and provide information and support to women healing from past birth experiences and preparing for future births. For further information, please access our website at www.ican-online.org or call (310) 542-6400. International Cesarean Awareness Network, Inc., 1304 Kingsdale Drive, Redondo Beach, CA 90278
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