The VBAC vs. Repeat Cesarean Debate

According to the World Health Organization more than one million babies are born by cesarean section in the United States each year.  They project that one half to two thirds of these surgical births are unnecessary and likely contribute to our unusually high infant and maternal mortality rates. 

Part of the rise is Cesarean section correlates with a decline in Vaginal Birth After Cesarean (VBAC) which has dropped by 67% in the last ten years. While evidence has shown that the majority of women who have had a prior cesarean can still have safe vaginal births, there has been much debate about the benefits and risks involved.  Despite the lack of consideration and general support from the medical community in promoting VBACs as an option, continued research has found the following pros and cons to both VBAC and Repeat Cesarean Section…

VBAC Facts…

The major concern when it comes to VBAC is that the uterine scar will give way during labor; an unlikely condition called Uterine Rupture.

Pros:

• 99.6% of VBAC’s do not have uterine rupture
• Risk of uterine rupture decreases by 50% after first VBAC
• Easier post-delivery recovery than cesarean
• Satisfaction of achieving vaginal delivery
• Sense of undoing prior negative experience
• Slightly safer for mother and baby (in most cases)
• Feeling of empowerment from trial labor

Cons:

• 0.4% risk of uterine rupture
• Risk of repeating prior negative experience if cesarean becomes necessary after a trial of labor
• Greater risk of infection for mothers who try VBAC and end up in cesarean
• Painful vaginal area for a few weeks after birth

Repeat Cesarean Facts…

Pros:

• Convenience for planning or scheduling childcare arrangements
• Avoidance of a repeat of the last labor-then-cesarean experience
• Decrease in need for an emergency cesarean
• Vaginal area remains unscathed

Cons:

• Increased risk of uterine infection and blood loss
• Possibility of prolonged physical pain and difficult recovery post-delivery affecting mother’s ability to bond and care for her newborn
• Often requires amniocentesis to check fetal lung maturity to avoid preemie delivery; consequently creating risk of miscarriage (which is 5-20 times greater than the risk of infant death or injury from a VBAC)
• Increased chance that the baby will have trouble clearing the fluid out of his or her lungs (naturally, without medical aid)
• Risk of surgical complications regarding bladder, bowel or blood vessel injury and infection
• Risk of complications during cesarean (primarily for the mother) increases with each additional elective cesarean
• Greater risk of emergency hysterectomy, hospital readmission, adhesions (internal scar tissue), infertility, hemorrhage, pulmonary embolism, heart attack, stroke or death