VBAC for a Lady Who Has Had 2 Previous C-sections

Specialties Ob/Gyn

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I'm writing this to get a feel of what other doctors are doing in other areas about VBACS. I'm a doula at a medium-sized city in the central US. I had a client call me and asked me if I could be her doula at a VBAC. Of course, I'm ready, willing and able, but then she says that it's a VBAC after two prior c-sections in which she never labored. It's kind of a long story, but she did consent to her first section after her OB, (not a cardiologist) discovered at one return visit that she had some slight tachycardia and that diagnosing the problem would have to wait after the baby was born. It turned out that her cardiac problem was benign, but she got pregnant again and was told that VBAC wasn't even an option in her area (she lives 3 hours from me in a rural area without any teaching schools or large hospitals nearby). But now, she is pregnant with her 3rd, and she desperately wants a VBAC despite the fact that she's had 2 c-sections, and that she's never labored before. She wasn't even given the option of TOL for her first.

She's called three different states and none of them will touch her with a ten foot pole. :rolleyes: She's placing all her hopes on one doc in this area who says he'll do a VBAC after 2 sections. However, I do not have a lot of faith in this doctor for various reasons. I'm afraid that he's setting her up to fail - he says that he'll do the c-sections, but I'm afraid that she's going to get to the hospital on D-Day and he'll say that the hospital won't let him do a VBAC., and he knew this all along.

After writing that novel, I'll get to my point. :p In any of your places of employment, will the docs do a VBAC on a lady that has 2 prior c-sections who has never labored? Or even, if your hospital does them at all.

I am so curious about this and I appreciate all the responses. Thank you!:)

Kat

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I work in a hospital where VBAC is a viable and successful option. Glad I do! And it depends, some docs indeed will allow TOLAC for a lady with two prior c/s, but not as often as when they have either already had a successful VBAC or just ONE c/s prior.

My former facility did them, the medical director was very passionate about the fact that they should be offered. The increased risk of rupture is marginal and the benefits of a lady partsl birth for mom/baby are proven. My current facility is like a 1950's horror film and does not offer them along with not allowing moms out of bed with ruptured membranes :uhoh3:

There are only a couple doctors in my area that will consider vba2c. I heard that one of them recently stopped doing them though. :( The risks are really pretty low and not significantly different than a VBAC after 1 c-section. A large study published in 2006 showed that the risk uterine rupture in a VBAC after multiple c-sections was only 0.9% while the risk of uterine rupture in a VBAC after 1 c-section was 0.7%.

After the NIH conference on VBAC determined that the risk of a baby dying following a uterine rupture was about 6%. So that means that the risk of a baby dying following a VBAmultipleC (the study included VBACs afte 2,3 and 4 c-section) is 6% of 0.9%.

Also, keep in mind that 25% of the women in the study were induced or augmented with pitocin. Induction is known to increase the risk of uterine rupture so this woman should really allow her labor to happen spontaneously to decrease her risk. The data for the study (which I referenced below) was also used in a 2004 study in the NEJM where the author showed that spontaneous labors has a uterine rupture rate of 0.4% (in that case all VBACs including VBAC after 1,2,3, or 4 c-sections, and VBACs on non-low transverse incisions were lumped together)

http://journals.lww.com/greenjournal/Fulltext/2006/07000/Risk_of_Uterine_Rupture_With_a_Trial_of_Labor_in.5.aspx

We do not do VBAC's at my facility...small community hosptial.

I once worked at such a facility that DID do a VBAC on a woman with exstrophy of the bladder, which was why she had the first section to begin with. :eek: This was not a planned incident, however, because she went into precipitous labor and started delivering by the time she arrived at the hospital. Mother and baby, BTW, were just fine.

:up: :)

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