are VBAC's pretty safe?

Specialties Ob/Gyn

Published

Specializes in med/surg.

I was hoping to get your input on how common it is that a VBAC ends up causing uterine rupture?- Is this something that you've seen?-and how does it turn out when it does happen?

Thanks!

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Hmm, I think the rates depend on where you go. I see you are in the US and from what I've read on this board, the US doesn't seem to favour VBACs. If properly monitored they are safe (less then 1% risk of rupture, all things being ideal).

Where I am we do a fair number of them. We have strict guidelines for who can even be a candidate and with proper screening you can eliminate most of those who are poor candidates for a VBAC. They are also very closely monitored and no VBAC are done out in the rural communities.

Ironically the only rupture I've ever seen was on a prime.

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I personally had a VBAC and I work PP and have MANY friends in L/D. They have not had a rupture in a very long time. They have had "alot" of pulmonary embolisms and "pulmonary flashes" or something like that name lately.

I pretty much refused a repeat C/S. I am a diabetic and had to be induced with Pitocin-which they did and when I had a prolonged contraction they quickly turned off the Pit and waited. 2 hours later the pit was back on. Delivered fine. I think they say no to ALL cervical ripening agents at our facility on VBAC's though. I don't really think doc's like to do them because its probably easier to schedule the cut. I WAS scheduled for a C/S the day after Thanksgiving last year and I went in on that Friday morning and had a nonstress test..all fine..basically got sick with worry about a repeat C/S and said NO..but I did say yes to induction with a possible C/S(it's always possible!) the following Wednesday. VBAC was the BEST delivery I ever had..Vag with #1, C/S with #2 and VBAC with #3!!

Sorry for the personal story..I am just all for the VBAC when it is appropriate and possible for the woman who wants a lady partsl delivery. If you are asking because you are facing a repeat C/S I encourage you to educate yourself but I felt totally safe and never had a regret about it!

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IMO - yes, VBACs are pretty safe. So are c/sections. On the flip side of that - VBACs carry some risks and c/sections carry some risks. Someone who chooses a VBAC over a c/section, or a repeat c/s over a VBAC, is choosing one set of risks over another. What I believe often happens is that the risk of VBACs are "hyped" a little more than the risks of c/sections.

I've seen a few ruptures. So far (knock on wood) all have ended OK for baby and mom. I have also seen one rupture with a pitocin induction - no prior c/section, no uterine surgery. Only risk factor was the pitocin.

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Specializes in L&D, High Risk OB, OR, Med-Surg, PHN.

]Depends on the comfort level of the pt and MD at the time of labor. No pitocin used on a VBAC and an OB managing the pt not a GP.

Lisa

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Specializes in Community, OB, Nursery.

I have personally never seen a uterine rupture with a VBAC. I have, however, seen a uterine rupture along the previous c/s incision (mom was at home, not in labor).

We do many many TOLACs where I am, and most are successful. I am really proud of that.

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

I think with proper prenatal care and a thorough understanding of patient history, VBAC is VERY safe. We do VBAC/TOLAC where I am and they succeed a majority of the time!

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I had a pp mom today; c-section number 5. I can't believe having five sections is good for your body. I don't know her story--whether she chose the four subsequent sections or if it was because our facility no longer attends VBACs. But wow, 5 sections. That's got to be hard on a uterus. I can't believe she hasn't had any problems thus far. I hope her next pregnancy (if there is on) goes as smoothly.

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Specializes in med/surg.

I agree! 5 c-sections? Wow- I might be more afraid of that then a VBAC.

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I know. I believe that hospitals' decisions not to attend VBACs are directly responsible for many of the problems that women will experience as we see more and more mothers with numerous c-sections. You cannot tell me that under most circumstances a vbac is less safe than pregnancy and repeat section following several previous sections.

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

Often this is NOT a hospital decision, but one mandated by INSURANCE CARRIERS as to whether TOLAC can be "allowed" or not.

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Specializes in L&D.

In order to safely do a VBAC, your hospital has to be able to do a C/S very quickly. In the rural hospital where I now work we do not do VBAC's on purpose because we do not have our own OB OR, and we do not have 24hr in house anesthesia or OR crew. So we have to wait for the crew to come in from home and/or to finish up the case they are now doing. So we only do the occasional accidential VBAC when someone delivers before the crew arrives and is ready. I call them "failed sections".

In the big city medical center where I used to work, we did a lot of TOLACs, most of them successful VBACs. I've seen a ruptured uterus twice, both were on Pit. One had a huge amount of pain that the epidural couldn't get rid of. Mother and baby did fine. The other had no pain; her baby was stillborn, but that wasn't related to the rupture. Mom was fine.

We used to schedule our repeat C/S after the due date to avoid the risk of iatrogenic near term problems. If they went into labor on their own, we could do the section quickly on any shift. If they lasted to the scheduled date, we were sure the baby wasn't preterm in any way. We often saw "windows" in the scars of those women. The scar separated without pain or bleeding and you could see the membranes thru the hole in the uterine wall.

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