VBAC statistics

[Mandyville]

I know I've seen a link here before but I can't unearth it again... Can anyone help me find the stats for the risks for planned VBAC vs. planned c-section? I seem to remember that the key difference was that planned c-sections hurt a lot less!!!

Also... Does anyone know what percentage of attempted VBACs are successful? I know it will differ from hospital to hospital... I have a leaflet which reckons the success rate is not a million miles off what it is for a first-timer (i.e. 80% success for first time VB; 75% success for first-time VBAC) but I may be making that up.

I HATE decisions!

Anyone?

its about 72-76% of VBACs are successful. If you google Green Top Paper VBAC it should link to the obsterics guide etc.

Hold on as i have been using documents a lot as i dont want to try for a VBAC so been studying them. I forgot i had them as favourites.

let me see if i can link:

www.homebirth.org.uk/vbacur.htm

www.rcog.org.uk/files/rcog-corp/uploaded-files/GT45BirthAfterPreviousCeasarean.pdf

www.bjog.org/details/news/591673/Risk_of_uterine_rupture_after_previous_caesarean_section.html

oooo looky it worked

OOh! I hadn't seen those! The link I had in mind might interest you, TheDoc. It has a table of relative risks (RR) and odds ratios (OR) for various outcomes for planned sections vs. planned VBs. It strikes me that if you are afraid of uterine rupture, or if you stress the extra risks of oxygen deprivation for the baby you're on strongest ground. I'm actually not sure what I want, though!

Let me try again to find it...

At our local hospital, of women attempting first time VBAC, 66% managed a vaginal delivery. Of those, 33% had an assisted delivery (which is the bit they don't mention unless asked!). I found those statistics distinctly uninspiring and am booked in for a repeat section on Monday (but most patients (75 %) do try for a normal delivery, and I'm perhaps a little over cautious).
Look at the NICE guidelines on C-Section for statistics re. liklihood of particular health issues between vaginal birth and C-section (but remember this does not distinguish between VBAC and other vaginal births or EMCS and ELCS).
Best of luck with your decision :)

I just can't get my head around it. The chance of success doesn't seem particularly different to first time round, but all the peripheral stuff is different. The hospital recommends continuous monitoring (which I found painful last time) and won't let VBACs into the pool (which I loved last time). I'm still motivated by a desire to get home as quickly as possible, but I can now see that two nights on the ward after good sleep is probably better than one night on the ward after a long labour.

My best buddy is making the same decision, but her deciding factor is different to mine (she went a long way overdue, believes that her pregnancies are naturally long and doesn't want the baby ejected too soon).

Have you spoken to the consultant mw about vbac waterbirth. My consultant doesn't support it but consultant mw did and I had one which was fab. Fourth time round my consultant is now ok with me trying this again but off course is stressing risks of no cfm. Our rupture rate is about 1 in 2000 but that's not complete rupture - just partial too. There are other ways to assess rupture for cfm and with my wb I got most senior mw allocated to me cos I was technically high risk. Rupture tends to be for those who've had old classic c section incision which is down the middle as opposed to across above the pubic bone.

Hi, I have no statistics but just wanted to add I have been in the same boat, in a dilemma whether or not to attempt VBAC or go for an elective section (1st birth was long labour then EMCS). For my second pregnancy I went for the elective section in the end and it was fine despite all the worries about risks of surgery etc.

The consultant looked through my notes to identify any potential problem areas and in doing that, it was found that not all of the potential complications of a CS necessarily applied to me (eg, anterior placenta complications as mine was posterior placenta). If you healed well from the first you are more likely to heal well again. If your baby from the first CS coped well being a CS birth and had a good APGAR. etc etc. which helps form a picture of the success of a subsequent CS (without there being any guarantees, obviously). So not all the known risks of CS would necessarily apply, or to put it another way you may be low risk for certain complications, which ups your chances of a successful ELCS. An individual review of your past birth will help you decide. Good luck!

Mandy did you find the link? That sounds just what I am after! Am trying to make the same decision myself. Although sounds like the decision is being removed due to the cuts, is your hospital in same boat? I.e. all being told have to try VBAC?

Doc thanks for the links you put on, are you planning on putting something together to take to your Obs appointment? I'm not sure how to go about remembering all the right information so will probably start to draft something.

Helzapoppin Are you on the NHS? I'm pg with second which will be a vbac if I choose that route. Have meeting with consultant at end of month but so far MW are pretty definite I should be going for a vbac. Issue is my medical notes don't exist (abroad last time, notes missing) and they are saying because I got to pushing stage last time then it will be 'easy' this time.

I just don't know what to do, as my old consultant told me I had 20% chance of vaginal delivery, yet MW seem insistent she was wrong (but she was at the bloody delivery and they weren't).

Sorry if I seem to be hijacking a friend, I'm just so grateful to find others in same conundrum.

OK, I found what I was looking for. Here: www.nice.org.uk/nicemedia/live/12156/54552/54552.pdf in Appendix E It's the summarised evidence tables for the recently closed NICE/NHS consultation on c-section guidance. The comparison is between planned VB and planned CS. This means that for c-sections, the risks are not inflated by adding in the emergency sections. Of course, it also means that the risks of VB seem lower because it includes all who plan to VB, not just those who plan to VBAC.

This is a table summarising the findings of many different studies (some of which will be better than others). When you look at the table, in the right hand column you'll see reported OR (odds ratios) or RR (relative risks). Some were NC (presumably "not calculated"). Where the number is less than 1, the risks are higher for planned VB.

I suppose the thing that bothers me here is that it's not that clear what the stats for VBAC are because so many women opt/are opted out of VBAC. The clinical trials numbers that TheDoctorsWife posted (72-75%) are (I THINK) the success rate for those who should try VBAC, not the success rate for those who DO try VBAC. Or maybe I am getting hung up again. Sigh...

SenoritaViva- I am on the NHS this time. Last time I had planned a homebirth with an independent MW. My consultant did not have access to my notes either. However, I did not actually go into established labour last time- my daughter's distress was picked up when my independent MW came to my house for a routine appointment and I was rushed in. Not having been into labour they have no idea how I would manage but it does decrease chances of a successful VBAC. Also, because of the circumstances of DD's birth, I am very nervous about something being 'missed' at the time around the birth (I think that we were very lucky to get her out safe and well).
I found attending the 'birth options' clinic (i.e. VBAC clinic) very helpful before I met with the consultant. I also spoke with my GP and a very experienced obstetrician (family friend) beforehand. It just helped me to get my thoughts in order and also meant that I'd 'rehearsed' the conversation when it came to meeting with my obstetrician, who has been supportive of my choice throughout.

Whilst I am mostly in the VBAC camp for my decision I found my initial appointment with Consultant unhelpful I was given stats and leaflet and basically told I am ideal candidate for VBAC. I found alot of my information since on the internet and here, and am infact not certain I am such a good candidate. I have to discuss mine at 36 week appointment which is really helpful as I didn't actually make it that far with my son I gave birth on the sunday morning and my 36 week appointment (for somethign different) was on the Monday. If that happens again I will becaome one of those stats either good or bad.
I was told at my 1st appointment I will be unable to have a waterbirth as this is their policy, CFM, only allowed to progress from stage 1 to 2 for an hour and stage 2 will be given no longer that 1 hour as this is their policy.
Not overally keen on the timescales they have in place and not overally keen on them intervening just because of ppolicy without any real evidence there is a problem.
Am I just being stupid though? I am not sure.
I guess they have these policies in place for a reason.
Waffle sorry.

75% Success rate here apparently but not certain how many of those are assisted or fully natural.

Thanks Helza

nunnie you have to follow hosp policy for things you want them to do e.g. use their pool. You do not have to follow their policy for things they want you to do/be done to you e.g. time limits. Hope that makes sense!

It makes perfect sense thank you Zimbah, the pool issue wasn't something I had considered to be honest so wasn't unhappy not to have a choice.

I've actually found the links that theDoctorsWife46 gave above quite helpful in confirming my decision to go for ELCS this time after EMCS for an undiagnosed breech first time around for my daughter. Although I was fully dilated (so therefore in their eyes my body is doing the right things, just that she was breech), I was overdue and I notice the stats seem to say that there are more risks for VBAC if you are overdue and have previously had a long labour.

Oh lots more helpful stuff added to this now, brilliant. I had a similar situation as helza in that last time I was having a home birth with indie midwife. I hate hospital and last time discharged myself 17 hours after my emcs. I absolutely do not want to try vbac for loads of reasons which include my hatred of hospital. It kills me to think of a hospital recovery after another c section but not as much as the thought of labouring there again. That coupled with the risks of a trial of labour, not having hormones in augmented labour etc I don't want it! My emcs was terrible in that I'd laboured for days, had the op and then dd popped out the most colicy screaming child. I got no sleep, no catch up and really struggled to cope.

I do not want to even risk that again. To labour to stillhave a c section when your so exhausted and this time a toddler who will want mummy back ASAP. I will right all my reasons down. I don't want a consultant assuming it's for convenience or a fear of pain but genuine misgivings. I can't afford my midwife again but I think I'll contact her in writing down my reasonings so she can help me formulate my argument. Sad that I already expect an argument and debate for something which is effectively a risk that should be yours to take not be persuaded into.

DoctorsWife, I don't actually feel this time that I could VBAC due to fear of uterine rupture. I also expect an argument and a debate (ironically the consultant said don't go scanning the internet too much for info lol) but IT IS MY CHOICE.

I am the same mrsaligee I have a huge fear of a uterine rupture which people keep telling me is very rare, but it doesn't seem to make a difference rare becomes insignificant when it is aimed at me and what can potentially happen to me and my unborn baby.
I am really hoping and praying my placenta is still low lying next week as I will then be an ELCS. As it stands now I am VBAC because they don't see any need for an ELCS. I am genuinely concerned and it is starting to affect me as I seem to have convinced myself it is all going to go horribly wrong.

Nunnie I assume you've had a previous CS, why have they catagorically said your down for a VBAC. What kind of argument/ discussion have you had? Im interested so I can forearm myself.

I contacted my midwife yesterday and said i wanted a CS and straight away she said had I thought about VBAC? If I could afford her again I may consider it at home, on the basis that I'd be more comfortable with someone I know and trust intensely and I suppose that may make it better. But it didnt last time! two days of labour and I once I hit hospital I was climbing the walls, impersonal, clinical, protocol...I was spoilt really with the one to one of my indie midwife.

I cannot even bear to think of being in hospital basically being "tested" in labour to see if Im a candidate for a successful VBAC. I'm pertrified of uterine rupture, its rare but its possible. and thats why i cant consider homebirth. Im at least 45 mins from hospital and I just cannot consider it or I'd go into debt for my independant midwife again.

The risk of uterine rupture is as i understand about 96 in 10,000 is that about 1 in 200? I'm hearing more and more stories abou people being refused a cs as they are good candidate for vbac. im sure im a good candidate, that doesnt stop it from being my body, my baby, my risk. Not someone elses to impose on me. where do that stand if they refuse my wishes, i get a rupture or similiar and it was against my wishes. If it resulted in hysterectomy or at worse death of mother or baby wheres the redress then?

They haven't catergorically said no but have basically said if my placenta is in a good position you WILL be having a VBAC won't you? Making me feel it wouldn't really be possible to say no without a good reason. I had an EMCS with DS due to him being brow in October and this one is due in September so less than a year ago. They are saying that because I have had a previous VB with DD in 2007 and because I made it to pushing with DS and quickly I am the ideal candidate for a VBAC.
The risk I believe is 1 in 200 yes, and as you say that does sound low, but when it is actually aimed at you and your baby it becomes quite high and does have a major bearing on the decision. As my scar is still pretty fresh this statistic interests me as I can't find out any information on how greater the risk is imposed on me.

If I had a 1 in 200 risk of downs I'd be considering extra tests. The cut off for that being high risk is 1:150! So not that far from rupture stats. I can see your predicament in that you've had a vaginal birth and got to pushing so they are looking at it that you can get there. But my stance on that is that didn't presumably have a scar under pressure at those births. On the links I put in I'm sure it states a scar less than a year is higher risk. As well as things like short stature, shoulder distocia etc.

At what stage do they even discuss vbac etc as I'm almost 14w and have first consultant appointment in sept.

They discussed mine at my 16 week consultant appointment with a few to have a decision by 36 week appointment. The midwife and subsequent consequent checkup with consultant have consisted of what I said above the assumption that I WILL have a VBAC. So I am not sure who has the final decision really.