VBAC 2 VBACWhat is VBAC? VBAC means Vaginal birth after cesarean (VBAC) where a woman decides to have abirth through the vagina after undergoing a previous caesarean section (Dickerson, 2010).Sometimes women opt to have a caesarian section to have a baby; consequently while having thesecond or next baby they opt for virginal birth. This practice leaves the mother confused as theyfear the risks that may occur in case of any complications. Mothers should therefore be clearlyinformed of the choices they make to an informed consent or refusal. As Baxter & Davies,(2010) states “The place of birth is also a critical issue, and many practitioners may beconcerned at the prospect of a woman with identified risk factors planning childbirth anywhereother than in a fully equipped unit.” VBAC is linked to Trial of labor after cesarean (TOLAC).TOLAC is the choice of a woman to labor and go for vaginal delivery after previous pregnanciesdone by caesarian.What are the risks versus benefits of doing VBAC versus C-section, after having a previous C-section? Long-term versus short-term? Women prefer VBAC due to experiences during prior births, medical recommendations,social obligations and/or personal expectations. The major risk of VBAC that is debated is theunsuccessful trial of labor that demands an emergency caesarian section (Baxter & Davies,2010). This ill in turn contribute to hysterectomy and expose the patients to other risk associatedwith surgery. Such risks include injury to uterus, bladder or other adjacent organs, anesthesiacomplications, subsequent fertility issues, and thrombosis of pelvis (Dickerson, 2010).
VBAC 3 VBAC also exposes the woman to uterine rapture that causes hemorrhage and blood loss;in addition it may cause perinatal death, a failed Trial of labor after cesarean (TOLAC) and apossible episiotomy or vaginal laceration (Dickerson, 2010). Dickerson continues to state that therates of VBAC have continued to fall with more women preferring a second caesarian rather thanbe exposed to the risks involved. He states that this is linked to physicians, preference of thepatients, and guidelines that are conservative in regards to emergent care. Uterine rapture can be impacted by many variables which include induction of labor,previous scars, maternal age, the number of caesarean done previously, and the interval betweenthe pregnancies. This will constitute the rapid response of an obstetric emergency due tohemorrhage (Dickerson, 2010). The benefits include less overall time to recover; this means that there is less time to stayin the hospital. The baby’s lungs are seen to clear during the birth process and hence VBAC is abetter beneficial in this. The woman also reduces the risks of infections during the caesarian andalso other risks that come with it (Dickerson, 2010). There is also decreased mortality, morbidityand including the rehospitalization of the patient. The neonatal risks involved include infections,fetal mortality, asphyxia, laceration, birth injury, head hemorrhage and celebral palsy. As McGrath, et al. (2010) states “A decreasing number of women are attempting VBAC,despite ample evidence that the practice is predominantly safe for mother and baby”: This meansthat mothers still view VBAC as risky despite its benefits, the recommendation would be toalways consult a physician to establish the facts before making any decision to avoid makingthem based on the wrong basis. Safety during birth is paramount and hence ensuring that themother is safe and all emergency equipment is available at birth is the first step to guarantee asuccessful birth.
VBAC 4 ReferenceBaxter, L. & Davies, S. (2010). Balancing risk and choice in childbirth after caesarean section. British Journal of Midwifery. 18 (10): 638 – 643Dickerson, T. (2010). The Rise and Fall of VBAC in the United States. Journal of Legal Nurse Consulting. 21 (1): 3 – 8McGrath, P., Phillips, E., & Vaughan G. (2010). Vaginal birth after Caesarean risk decision- making: Australian ﬁndings on the mothers’ perspective. International Journal of Nursing Practice. 16: 274–281