Midwife Monday-Risks of Multiple Cesareans
Midwife Monday-Risks of multiple CesareansPosted by Holistic Heritage Homebirth on Monday, February 4, 2019
This week Jaelin Stickels, CNM, WHNP talks about Vaginal Birth after Cesarean. How safe is it and what are the risk?
- 1970 crate/s was 5%
- 1980 17%
- 1988 25 %
- 1996 WHO mandates 10-15% Healthy People 2000 had a goal to decrease c/s rate by 20% which did happen for a short period of time and then we had a big increase by the mid 1990’s
- 2009-today 33% -60% today That is a 600% growth rate since the 1970’s
Do you really think women suddenly were unable to deliver vaginally, so why?
- Decrease fetal deaths-suddenly vaginal births are too dangerous for the baby
- Research revealed there were more fetal deaths and complications with c/s
- Malpractice-fear of being sued
- Malpractice suits did have a big jump in the 1980s due to complications associated with c/s. This is because c/s is a major surgery and there are more opportunities for things to go wrong.
- Truth is physicians overturn over 90% of malpractice cases.
- Last reason: it’s women’s fault for being too old, too fat, and evolution of women’s bodies are growing babies too big!
- Other reasons: protects against pelvic floor dysfunction and women requesting elective c/s
Main Reason: Follow the Money
WHAT DOES THE RESEARCH SHOW ABOUT VBAC?
The big worry is always Rupture of the uterine scar. VBAC were more common up until 1996. What happened?—Cytotec early 1990s-There were more ruptures and post partum hemorrhages which led physicians to stop offering VBAC.
- Normal risk: .007% vs c/s .64%
- This risk decreases with spontaneous labor and no augmentation
- Risk for Mother—No maternal deaths with VBACs vs 21 per 100,000 births with cesarean
- Risks for Baby—This is a little trickier as the research is all over the place. Some says more increase, some say less risks, some say its equal risks as compared with c/s.
- 6% of ruptures are fatal for the infant
- 14-33% of ruptures require a hysterectomy
- A number of factors are known to increase the risk of rupture such as induction of labor and the number of previous c/s-however with each additional c/s comes a greater increase of maternal/fetal mortality and complications.
- Prior vaginal birth decreases risks of rupture by 600%
- The NIH panel concluded that a trial of labor is a reasonable option for many pregnant women with one prior C-section with a low transverse uterine incision.
- AHRQ-agency for healthcare research and quality states with physician care successful VBAC 74% vs 87% with out of hospital births. With rupture rates for out of hospital as low as 1% in some studies (Meaning out of all the ruptures that do occur, only 1% happens out of the hospital). Research shows it comes down to provider care!!!!
- Let’s talk about multiple c/s and risk factors: With each additional surgery risks of maternal mortality increases and a much higher rate than uterine rupture increases AHRQ reports 74% success rate for VBAC with multiple prior c/s. Again depends on the care provider.
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