Vaginal Birth After Cesarean — What Are The Risks?  

Would you like to have a vaginal birth after cesarean, but are worried about the risks involved with this choice? Up to date research shows that women making the decision whether to have a repeat cesarean section or try for a VBAC are not informed about the risks and benefits of both options at all.

The researchers' conclusion was that both repeat cesarean and VBAC are relatively safe in most cases, but that the lack of informed consent is a real problem. “Informed” is an integral part of “informed consent”, a doctrine that requires doctors to inform their patients about the risks and benefits of a medical care choice, so that they can agree or disagree. Without the facts, you cannot make a good decision. So, if your OBGYN just tells you to have a c-section again without even letting you know that a VBAC might be an option, that's not informed consent.

So, what are the risks involved with a VBAC, or trial or labor after c-section? 

Uterine Rupture

Uterine rupture is the one risk everyone talks about. This means that the uterus ruptures along the line of the previous cesarean incision during labor. There are two types of uterine rupture. With catastrophic uterine rupture, the uterus tears open along the scar line, and its whole contents are released into the abdominal cavity. This results in a lot of internal bleeding and both mom and baby's lives are in immediate danger as a result. 

Asymptomatic Uterine Rupture

Asymptomatic uterine rupture is the more common kind of uterine rupture. In this case, the scar opens part of the way, and the baby and amniotic sac remain inside. This is a dangerous situation to be sure, but everyone usually makes it through OK if a hospital is close by — which is definitely the case if you're having a VBAC in a hospital, as you'll be very carefully monitored. 

One in 200 women attempting a VBAC will rupture, which equals 0.5 percent of VBAC cases. Some of the possible consequences of uterine rupture are fetal death and hysterectomy — where the uterus has to be removed in an emergency procedure to stop the hemorrhage. A 2004 study published in the British Medical Journal shows the statistics: 

• Zero percent of uterine ruptures resulted in maternal death.

• Five percent of uterine ruptures resulted in fetal death.

• Thirteen percent of uterine ruptures resulted in hysterectomy.

 It is interesting to note that several other labor complications, not related to VBAC, are statistically more likely to occur during your vaginal birth after cesarean. They include shoulder dystocia, placental abruption, and umbilical cord prolapse.