A panel of doctors convened at the National Institutes of Health recently reaffirmed the safety of vaginal birth after Caesarean section (VBAC) for approximately 70 percent of affected women. In light of the general safety of VBAC, the NIH panel recommended that the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists reconsider their guidelines.
Under current guidelines, many doctors and hospitals refuse to consider VBAC; many doctors fear that the uterine scar from the initial C-section might rupture during a vaginal birth. But in an interesting twist, the experts say that VBAC is often safer for the mother than a repeat Caesarean. However, they also note that a repeat Caesarean may be safer for the baby in some cases.
The evidence remains controversial. Whereas the NIH panel said a repeat Caesarean is slightly safer for baby than VBAC, numerous studies contradict that assertion. The medical establishment frequently objects to VBAC for pragmatic reasons, including the possibility of emergency Caesarean if VBAC fails in an individual case.
According to the Coalition for Improving Maternity Services though, women undergoing Caesareans are more likely than women undergoing vaginal births to suffer several serious complications. These complications may include accidental surgical cuts to internal organs, major infection, emergency hysterectomy due to uncontrolled bleeding, blood clots leading to stroke or pulmonary embolism, and even death.
About 1 percent of women undergoing VBAC rather than a repeat Caesarean are at risk of uterine scar rupture, a potentially life-threatening condition. Women with low-transverse incisions, the most common type, are unlikely to suffer uterine scar rupture during VBAC.
Ultimately, the best decision for a woman and a fetus depends on the individual situation; the NIH panel is not recommending that all women should be candidates for VBAC or that they should be required to have repeat C-sections. Doctors must carefully monitor each individual situation and make appropriate decisions based on the situation, to ensure the safety of both mother and baby.