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:

bulletIf 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.
bulletIf 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:

bulletFailure to Progress
bulletPosition of baby (Frank Breech)
bulletbaby in distress
bulletmother 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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