Why Are Doctors Against VBACs? It Requires A Bit Of A History Lesson

No matter how your baby arrives on this planet, people have all the questions. Did you deliver naturally? Was it a vaginal birth? Oh, you had a C-section, huh? The truth is, it's not really anyone's business, but pregnancy has a way of making your vagina personal property. Still, when it comes to C-sections, there are a lot of questions surrounding the possibility of a vaginal birth after a C-section (VBAC). But why are doctors against VBACs? It turns out, the learning curve has been a long one.

"In the late 1960s and early '70s, a new obstetric standard was instituted — once a patient had a cesarean, all her subsequent deliveries would be by cesarean," Dr. G. Thomas Ruiz, OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells Romper in an email interview. "The lead to the change was the risk of uterine rupture in women attempting a VBAC."

But, Ruiz explains, while it was initially believed the uterine rupture rate for VBACs was as high at 10 to 15 percent, the rupture rate was re-investigated in the late 80s to assess uterine incision type. "It was determined that women with a low vertical or a classic incision (vertical in the mid-uterus) had a 15 percent risk of uterine rupture, while the rate of rupture in women having a low transverse incision was 1 to 2 percent."

"Based on this data, if a women with a documented low transverse scar wanted to attempt a VBAC, we would encourage it as long as the baby was being continuously monitored," he says. "The result was a decrease in C-sections in the '90s as compared to the '80s."

But then in the 2000s, the American College of Obstetrics and Gynecology (ACOG) put out an advisement that if a woman was to attempt a VBAC, there must be an obstetrician readily available in case an emergent operative delivery is required, Ruiz says. "Most community obstetricians monitor labor remotely, home or office, and come in to deliver the baby when the mother begins to push," he says. "Because a community OB could not afford the time to be present in the hospital the entire labor process, it was more convenient to schedule a repeat C-section."

But new guidelines set forth by ACOG, as well as a trend in labor units to employ in-house obstetricians, have helped make VBACs a more viable option, Ruiz says. "The rate of vaginal delivery post-cesarean is 60 to 70 percent regardless of the reason the initial C-section was done," he says.

According to LiveScience, most women who had a previous C-section scheduled another C-section for their subsequent birth, but about 20 percent attempted to give birth vaginally. Of these, about 70 percent had a successful vaginal delivery, whereas the other 30 percent ended up needing a C-section, according to a report from the Centers for Disease Control and Prevention (CDC).

"If we are to be successful in lowering the C-section rate, we need to support the labor process and encourage VBACs," Ruiz says. "Provide labor education to all our prenatal care patients. Encourage labor units to hire in-house obstetrics hospitalist. There is no question recovering from a vaginal delivery is much easier then recovering from a C-section.”

Ruiz says the most common reasons for a C-section include: the baby is too big for the mother's pelvis as a result of a large baby or small maternal pelvis, or the fetal head enters the pelvis with the face looking at the ceiling. "The other common reasons include fetal distress, a fetal butt first presentation (breech presentation), abnormal uterine bleeding in the third trimester, and the last big contributor to our current C-section rate is repeat C-sections," he says.

If you have had a C-section and are curious about a VBAC with future babies, then it's important to talk to your healthcare provider. The good news? It is possible (for the most part) to healthfully deliver a baby vaginally after a C-section. And don't let anyone convince you otherwise.

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