VBAC – Myths and Risks

Dr Vijaya Krishnan talks about Myths and Risks associated with VBAC and what really is achievable when it comes to birth

Let us talk now about what are the myths versus what are the facts when we are looking at having a successful VBAC, and really what are the risks that you’re looking at if you’re comparing like apples to apples, right? So one of the things that we go over is we side by side, we’ve talked to the woman and say, and the partner and say, okay these are the benefits of having a VBAC. And these are the benefits of having a planned C section. And when we look at it, what we find is that if you have three out of thousand women, and this is, I’m talking of thousand women who are in good, strong, active labor. Your early labor does not cause any problems whatsoever.

All the studies that were done also do not tell us whether this was a woman after one previous C-section or two previous C-sections. We don’t know whether she was induced or not induced. So all the having to adjust for so many, different parameters. It’s really hard to come to a conclusion.

But even so, even if we come to take out all those factors, what we know is that if a woman goes into good, strong, active labor. Three out of the thousand women may have an increased risk of scar rupture. Now, when we look at scar rupture, this is not as if a tire is blowing out. We have to understand that scar rupture really means that is a tinning out of the scar at the lower segment.

And the other factor that nobody tells you is that when the scar thins out, the body actually gives some signs. Oftentimes these, they talk about silent rupture. The reason they’re talking about silent rupture is that there has been no human contact looking at the woman as a whole person. What they have said is if you put a continuous electronic fetal monitoring, for example, that might not pick out the signs before she goes into it a rupture. Whereas again, from practice, what we know is that continuous labor support has its weight in gold as with every woman, but specifically for the VBAC woman.

But then we tend to pick out signs, or the woman tends to tell us things which alerts us that this may be a case to be watched more carefully. And if you watch that woman more carefully, what we do know is that we can identify which women are at that slightly increased risk and make preparations for alternate means of delivery, which might be cesarean section, which might be, you know, speeding up the birth at that point of time.

But their body is very, very smart. It gives us those indications and ideally, in a situation where you can get the woman from the decision to incision, meaning having a repeat C-section within a half hour to 40 minutes, the woman is usually safe to have her baby.