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Induction during labor after a cesarean
Although induction may seem like a good option, and is not contraindicated in VBAC labors, induction may pose a greater risk for women planning a VBAC. It is important to weigh the risks and benefits and carefully consider the reason for a suggested induction. You should discuss induction with your healthcare practitioner.
VBAC after multiple cesareans?
Many women have delivered their babies vaginally, even with more than one prior cesarean. A vaginal birth after multiple cesareans, for many woman, may be a low risk option. It is important that a woman is well-educated and informed before making the choice to VBAC after multiple cesareans. You should discuss this risks, benefits, and alternatives with your healthcare practitioner.
Help! I’m being forced or pressured to have a cesarean. What can I do?
Mandated surgery is unethical. You have the right to receive unbiased counseling on the risks, benefits, and alternatives of each recommended treatment or procedure. You then have the right to informed decision making, which means saying ‘yes’ or ‘no’ to the procedure or treatment. If you feel you are being pressured or forced into having a cesarean you should contact the patient advocate at the hospital, an attorney, or hire an independent advocate to attend appointments or your birth with you.
Help! My hospital has a VBAC ban. What can I do?
Many hospitals have bans on VBACs or bans on VBACs after multiple cesareans. These bans can make it harder for women to have a VBAC, however, these bans do not mean that the woman must submit to a repeat cesarean. Every patient has the right to refuse treatment. This includes the right of a pregnant woman to refuse another cesarean. Even if a ban is in place, a hospital cannot turn away a mother in labor and will be forced to care for her to the best of their ability, despite her refusal of the cesarean.
Who is a good candidate for a VBAC?
Each and every pregnancy is different and it is important for women to evaluate their own situation carefully with the assistance and guidance of a trusted caregiver. Although there are some specific definitions set in place by organizations such as ACOG defining who is and isn’t considered a “good candidate” for a trial of labor after cesarean, it should be determined based on each woman’s specific circumstances whether or not a VBAC is the best option. You should discuss VBAC with your healthcare practitioner.
Are VBAC’s safe?
When discussing a VBAC, the primary concern of any individual is that of uterine rupture. Uterine rupture occurs when a separation of the uterine wall occurs at the scar of the previous cesarean. Uterine rupture can be life-threatening and serious, however, the risk of uterine rupture occurring is very rare, affecting less than 1% of women who attempt a VBAC. After a woman has had a VBAC, her risk of uterine rupture decreases more with each vaginal delivery.
What is a VBAC?
As the meaning behind the acronym implies, a VBAC is a vaginal birth after a prior cesarean. A woman who has had a VBAC was able to deliver her baby vaginally without surgical intervention, even with a prior cesarean. Many women who attempt a VBAC will go on to have their babies vaginally.
What does ‘VBAC’ stand for?
The term “VBAC” is an acronym for vaginal birth after cesarean. Other variations of this acronym may be used to describe more specific birth situations, such as HBAC (home birth after cesarean), or VBA2C (vaginal birth after two cesareans).
What are some common reasons a provider might recommend a cesarean?
Obstetrical emergencies like:
-prolapsed cord (where the cord comes down before the baby)
-placental abruption (where the placenta separates before the birth)
-placenta previa (where the placenta partially or completely covers the cervix)
-placenta accreta (where the placenta is too deeply embedded in the uterine wall and has potential for maternal hemorrhage)
-eclampsia/pre-eclampsia (pregnancy-induced high blood pressure, causes severe swelling due to water retention, and can impair kidney and liver function. If it progresses to eclampsia, toxemia is potentially fatal for mother and child.)
Other common reasons we hear for cesarean are:
-fetal malpresentation such as transverse lie or breech (many women are not given a full range of options such as vaginal breech birth with a skilled provider or external cephalic version to turn a malpositioned baby)
-suspected cephalopelvic disproportion aka CPD – (meaning that the head is too large to fit through the pelvis. Actual condition is very rare. This is often over diagnosed, and many women do go on to have vaginal births after a cesarean for CPD)
-Maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc.)
-fetal distress. (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.)