Many women who have had a c-section before will end up with a repeat cesarean the next time they have a baby, for various reasons. A new study finds that many pregnant women who face this decision don't have all the right information.
Repeat cesareans and VBAC are both safe but informed consent matters
A research team led by Dr Sarah N Bernstein surveyed 155 pregnant women who has previously had a cesarean section. The goal was to find out whether the women, who were all good candidates for a vaginal birth after c-section (also referred to as a "trial of labor" in hospitals), were aware of the risks and advantages of both options. Previous studies on the topic of the relative safety of vaginal births after c-section vs repeat cesarean sections have drawn contradicting conclusions. It's very clear that "once a c-section, always a c-section" is an outdated approach. At the same time, some women are clearly not good candidates for a trial of labor, or vaginal birth after cesarean (VBAC). Dr Bernstein talked about her views on that, pointing out that "the point of this is not to say that one option is better than the other". "They are both safe options," Dr Bernstein said, but she added that her research team felt strongly that women should make their decision with as much information as possible. Their survey found that's not currently happening at all. Let's take a look at the key findings of this study, which was published in the American Journal of Obstetrics & Gynecology.
How women answered the survey
- Out of the 155 women surveyed, 87 had chosen to try for a vaginal delivery, while the remaining 86 chose a repeat cesarean section.
- The women who opted to have a repeat c-section had no idea about the success rates of a trial of labor after c-section only four percent answered multiple choice questions about this correctly. Most didn't even try to guess. Between 60 and 80 percent of those women who try for a VBAC succeed, in case you were curious.
- Women who chose a trial of labor didn't do much better answering that same question. A slightly higher 13 percent either knew or guessed the right answer, and 54 percent indicated they didn't know.
- You'd think that women who had already gone through a c-section before would know what's entailed. Strangely enough, only 40 percent of those who chose a repeat cesarean knew that their choice would mean a longer postpartum recovery time.
- Almost 75 percent of the women having a repeat cesarean section didn't know the risk of uterine rupture during a vaginal birth after c-section. Uterine rupture, a complication with a high risk of death, is one of the reasons repeat c-sections are often seen as safer. The risk is only 0.5 percent on average, however.
To c-section or not to c-section, that is the question
Dr Bernstein's conclusion was that women who face this difficult choice should have a serious conversation with their OBGYN about their options and the risks of both a trial of labor and a repeat cesarean section, instead of getting "information" from friends and magazines. Here at Trying To Conceive, we're sure that hospitals play a part in keeping the c-section rate up, too the 32 percent c-section rate in the United States may be high, but repeat cesarean sections actually make up a large percentage of total c-sections. The American College of Obstetricians and Gynecologists (ACOG) does have guidelines supporting VBAC, and the organization is officially concerned about the high c-section rate in the US. Still, it's no secret that many doctors and hospitals have "bans" on vaginal births after cesarean section. The reasons can include concerns over liability insurance, and not having the right personnel on staff when a trial of labor takes place, in case an emergency c-section becomes necessary.