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Are you at increased risk when you have a c-section and then
go back to vaginal birth?
Canada AM had their Health and Medical Contributor, Dr.
Marla Shapiro, discussing a recent study regarding the risk of VBAC.
Transcript, July 6, 2001
Dr. S: The question is "Are you at increased risk when you have a
c-section and then go back to vaginal birth?" Sixty percent of women who
have a c-section elect to go back and try a vaginal delivery. One: For the
experience and Two: because a vaginal delivery is easier to recover from then
major abdominal surgery.
Dan: The results of the study are?
Dr. S: Actually, as high as 15 times more likely to suffer a uterine
rupture. If you look at the numbers, what it tells us is:
 | If you have a repeat c-section, your risk of a spontaneous uterine
rupture is about 1.5 per thousand. And then we saw that for women who had a
normal delivery afterwards, spontaneously went into delivery (?), their risk
of a spontaneous rupture was three fold.
| | If they were induced with medications, other then the class of medications
called prostaglandins, it was five fold, but if they were induced with this
class of medications called prostaglandins to deliver, it was as high as
fifteen fold and that's called the relative risk. |
Dan: How serious is uterine rupture?
Dr. S: It is very serious. Very worst can cause maternal or perinatal
death. More likely can cause a surgical emergency (hysterectomy (?), infection,
bleeding). You have to remember that you're looking at a very rare event. In
these 20,000 women, you were looking at a total of 91 women who had a
spontaneous rupture but the risk increased. You're talking about very, very
small numbers but nevertheless, the risk increases significantly depending on
how you have this vaginal delivery.
Dan: Was this rupture along the scar line?
Dr. S: That they don't tell us. I don't know if that's necessarily
important.
Dan: C-sections have a bit of a bad rap. Many people have suggested that
some doctors leap to them too quickly because they are convenient for medical
staff, not necessarily the patient. (My comments: Ouch, Dan!!). What are
the reasons that we have c-sections?
Dr. S: The medical reasons are:
| Failure to Progress
| | Position of baby (Frank Breech)
| | baby in distress
| | mother who has certain illnesses |
Dan: Can you tell us in broad strokes how many Canadian women have a
c-section?
Dr. S: The numbers are about 22% in terms of delivery.
Dan: So, the numbers are really big?
Dr. S: Those are relatively big numbers.
Dan: And how many of those who attempt, come back and have normal,
vaginal deliveries?
Dr. S: Sixty percent of them attempt to do that and the question that has
been asked all this time is is there an increased risk. And this is the first
study that tells us "Yes, there is an increased risk."
Dan: In 30 seconds, what does it mean to you?
Dr. S: It means that you should not ignore the possibility of a vaginal
delivery but that you should be aware of the risks. You should sit down with
your doctor and talk about the delivery and also it would tell me that for women
who have had a c-section, a homebirth for vaginal delivery second time around
would be a risky procedure. You should be in a place that should you decide to
go vaginally and have problems, they can be attended to medically.
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