Repeat caesarean or VBAC?

There has been a lot of coverage in the media over the last few years quoting research looking at the comparative safety of a repeat caesarean versus a vaginal birth after caesarean (VBAC).

The findings are invariably such that the research can be used both by protagonists wanting to reduce the caesarean rate and those wanting to promote the validity of repeat caesarean birth (particularly maternal request CS). In other words it is still very much a matter of personal opinion.

What is clear is that for women trying to make decisions about their birth plans the risks typcially being discussed (e.g. scar rupture, fetal death and haemorage) are, with either delivery mode, incredibly small.

While findings can be manipulated to make controvercial headlines all current research can really emphasise is that rather than making snap decisions one way or the other women need to evaluate the broader risks of both modes of birth in their specific situation and make their decision based on their preference once fully informed.

So revisiting pre-conceptions and assessing the quality of the information you are given is of paramount importance. For example: Hemorrhage risks are incredibly small (2.3% in planned VBAC and 0.8% in planned caesarean). Despite this some women, who would prefer a vaginal birth, rule out an attempt accepting a potentially ‘unnecessary caesarean’ because they have not been given the full facts. Conversely those women, for whom the risks associated with a planned caesarean feel more acceptable than the risks associated with a failed vaginal attempt, may not consider a prophylactic caesarean because they feel unable to challenge the popular opinion being pushed by the media and natural birth advocates that VBAC is better.

It is important that women feel empowered to make decisions, that they are involved in the decision making process and that they challenge the advice they are given. Afterall they are the ones that have to come to terms with the outcome.

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