To VBAC or not to VBAC?

One of the more important risks associated with caesarean birth is the increased likelihood of placenta accreta (abnormal attachment of the placenta to the uterus) in future pregnancies. Placenta accreta is a serious obstetrical complication, and the risk increases with each subsequent C-section.

But vaginal delivery can also have risks. Operative vaginal deliveries – those that involve forceps or a vacuum – can have high complication rates, Dr. Akoury said.

‘If we’re going to be insistent on reducing caesarean section, vaginal delivery will go up and concurrently, operative vaginal delivery will go up,’ he said.

Vaginal delivery can result in pelvic floor dysfunction, such as incontinence. Risk is higher for first-time mothers, those with large babies and those who have a prolonged second stage of labour.

For women attempting VBAC, risks include uterine rupture or tearing of their C-section scar. Compared to a successful VBAC, a failed VBAC attempt triples these risks, and more than doubles the risk of hysterectomy.

Dr. Akoury notes that uterine rupture is rare, and affects a small number of women.

In terms of risks to the baby, fetal death during labour is more frequent in VBAC, and so is oxygen deprivation, which can cause damage to the brain and central nervous system. Once again, Dr. Akoury noted that these are rare occurrences. The rate of neonatal deaths is similar for VBAC and caesarean births.

‘To summarize, maternal morbidity is probably slightly higher in caesarean section than VBAC. Maternal mortality is (also) slightly higher with the elective section,’ Dr. Akoury said. ‘Perinatal mortality and severe complications occur more frequently, but in small numbers, with a VBAC.’

The overall caesarean rate continues to rise, which means more women will be making choices about attempting VBAC or having an elective C-section during a subsequent pregnancy. Information about the risks and benefits of both options will be critical for making these decisions.

Women’s College Hospital

This article has been provided by women’s health specialists at The Women’s College Hospital. To learn more about women’s health, visit their website . © 2000-2013 Women’s College.

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