risks in 'normal' vaginal birth vs risks of vbac

[asur]

just curious.. have read loads about the risks of scar rupture etc in vbacs. The risk is only about 0.5-1% (from what I've read) This seems quite low...

What are the relative risks of a major complication of a 'normal' (ie no previous cs) vaginal birth?

Is a VBAC really any more 'risky' than VBwithoutC?!

Not trying to start a debate or anything, am just curious and figured this was a good place to find the answer...

Thanks

IMO - no.

there is a risk of rupture-- very small. but apart from that, i don't believe it is any more risky. there are risks with every birth, vaginal, C.S , VBAC...

i believe the risk of rupture is less than the risk of cord prolapse..which is a risk in every single birth.

thank you lulu, knew I would get a good answer on here - you are very wise

The risk are a) rupture of womb/scar, and b) higher than average risk of emergency c/s. The risk of rupture is typically less than 1%, and even then, whilst it will tend to lead to an emergency c/s, it does not always lead to further complications (my friend's womb ruptured during her attempted vbac and the staff didn't realise for several hours).

The main "risk" is that you have a higher than average risk of needing an emergency c/s, and typically the risks of an emergency c/s are higher than those associated with an elective (though both are higher than a vaginal birth). Depending on the reason for previous c/s (and in particular the likelihood of a similar situation occuring in a subsequent pg) the risk of an emergency c/s is typically at least 25% and can be as high as 70% in some cases.

Even then the comparative risks of emergency vs elective are lower, but I had my emergency c/s performed by someone who had been on duty for 20 hours with a consultant available by phone - probably wouldn't have been the case with an elective.

For most patients the medical risks of a vbac are relativley low. However you should still weigh up the impact of the greater probability of an emergency c/s. I covered this ground with my consultant in some detail - we concluded that my chances of a successful vbac were around 50%, and based on that I went for an elective.

i do agree with LadyMuck to a certain extent

the chances of VBAC tend to be around 60 - 70 % . whereas a woman pregnant with her first baby tend to have odds of a vaginal delivery are around 70 - 75 %

a lot depends on the trust area . the statistics re caesarean can vary.

i think the reason there mgith be an increased risk of VBAC ending in another CS is due to hospital management of VBAC -

continous monitroring, not allowing woman to labour actively, not allowing women to labour over a certain time frame. etc..

if a c.s was performed due to a breech baby..no reason a VBAC should not be advised and achieved. If a c.s done because the baby was malpresenting..eg brow presentation,..then also, it should be advised to go for VBAC as the odds of that happening again are low.

each case needs to be weighed on its attendant merits, but all too often mothers have to fight fro a VBAC when there is no need due to twitchy consultants who make it sound like a life or death scenario.

as i said, there are risks in every birth,....but vaginal delivery, is IMHO, the one to aim for if it is medically indicated.

my odds of VBAC were given as 50 -50 - i went for it and had a really positive vaginal birth.

i think that it is very diffiuclt to predict the outcome of a birth!
you have to make an informed choice, based on the past and present situations.

To Ladymuck...hm...I thought that if the womb has ruptured then it's an immediate emergency situation that needs immediate action...so, how did your friend get through this, when it wasn't detected early on?
Also, the op's question was actually if a first Birth that is a vaginal Birth really is much lower in risk then a VBAC, it wasn't a question if one should go for VBAC or Section...iykwim!Well, unless I have misunderstood the op, now, that is!
To the op...I really don't know just how much lower risk a first or any vaginal Birth without there ever been a C-section compared to a VBAC is, sorry!
I know, that even in a Uterus that never went through a section, there still is some risk of Uterine rupture , but I think it must be even lower...I know, that forinstance the "excuse" on my Birthnotes was that I had develloped Bandles Ring and that that could lead to Uterine rupture, which was part of the reason why I ended up with an emergency Section with my 3....saying that, if that is true, I mean, that I actually had this, I doubt it very muhc, but yes, if I did have it, it may well saved mine and my ys's life...!

It also depends on the reason for the caesarian first time round. When I talked to a consultant about it for a piece I did a while back, she said that was the crucial factor.

if the womb fully ruptures.. the mother and foetus are at risk of imminent death..sorry to be blunt.... a scar can start to rupture ...and doesn't necc. totally open the uterus. Signs will show both in the mother and in any monitoring of the foetus.

....but as far as i am aware...the VBAC is not actually statistically that much more dangerous than a VB !! smaller additional risk of rupture.

3and- bandles ring......very rare i believe !! and is an indication for rupture..and of obstructed labour....

lulu, I know it is extremely rare, and that is one of the reasons that I don't believe I have had it, and that it would put there as a reason that I could "not" argue with!
Thing is, teh mw that was with me at home (was meant to have a Homebirth, and got fully dilated, too, did also the after care, and when I asked her about it, she said that I didn't have it, and when I showed her it in teh notes, she still said, nope, and she wasn't told about neither, and I suppose she would have been told about it, iykwim...then when I saw a Consultant a few weeks after the Birth, I mentioned that the Community m/w that attnedted to me told me that I didn't have it, but that in my notes it stated it and who could I believe, and she made a wishy washy explanation, that if it said it in my notes than I must have had it.....pretty non-commitical....and I think that if I have had it, then they would have all known about it, because it is so damn rare....and they wonder why it took me so long to get over all of this crap....I mena, maybe if I felt I could trust and believe them it wouldn't have taken so long....sorry, I know I am ranting...but it does annoy me soooo much, and when people say things like one should trust their consultant...I can't help but become a cynic, lol!
Anyway, sorry to OP.....I am hi-jacking your thread!

this makes interesting reading I think Funnily enough, when I put in risk with Vaginal Birth, all the Info seems to be VBAC related!

sounds a bit odd...if the midwife wanted to get you in for c.s , she chose something very peculiar and rare as an indication.......if indeed, as you say, it happened....! good link

3andnomore - the baby stayed within the uterus and was delivered by emergency c/s. The signs of rupture aren't always obvious, especially if the mother is trying to avoid continuous monitoring (which most women wanting vbacs will try to do). The reason cited for the emergency c/section was failure to progress and foetal distress - it was only when the cs was performed that the rupture was apparent. Thankfully they had already decided that this was to be their last child.

In terms of comparing relative risks of vbac and normal birth then the increased likelihood of emergency c/s is a pertinent factor. If you takes electives out of the equation, the emergency section rate for a first labour is typically 10-15% whereas the rate for vbac is 25%+.

no the mw had me transferrred, as I was fully dilated and nothing had happened, etc... (turned out he was in Military position and OP, which would explain WHY he took his time to come down more, iykwim)...the m/w was the one that over and over told me that I didn't have a bandls ring, no matter what the notes say...and I would think that she would have been told about it, because she cared for me in labour and then when I was back at home....if anything it was the Hospital that "made" it up...

Lady Muck...must have been all very scary for your friend, I assume all is well with her and her child now?

Lady...i am intersted in those stats...where did you get them?

Thing was, lulu, it wasn't the only thing that was "made" up, neither...the Consultant I saw for the aftertalk pointed out, cleverly as she thought, that my ys was on the verge of distress, as they took the cord bloods and ph was low....well....I then pointed out to her, that, my ys had a apgar of 9, which is hardly an indication of distress, and that the cord bloods would have been taken after the Spinal was set, the Ventouse failed and the C-section....so, without any of those the ph would have been most likely fine....but of course that would have meant patience and helping me labour better ratehr then being Intervention happy....oh....I know, over 2 years on and still got my issues...one day I will be over it, lol...

if CFM is being relied on to detect rupture then that is not best practice. IMHO......i had the continual monitoring,...but the midwife wasn't in the room half the time!! there are other indications rather than foetal distress.

what happened to your friend is awful and frightening , i am sorry she had such a bad experience.

anyway....i think that a lot of it comes down to the personal experience of previous labour and the reason for previous c,s, and sadly, the confidence of the obs. in the birth process.

statistics can be an indicator. but each case needs to be taken on its own merits. i don;t want to get into a pro vbac debate, that wasn't the op!!

sounds crappy 3and...have you had been in touch with a birth crisis organization? sorry for hijack!

Lulu, well...I used to visit a Birth debriefing Board a lot, but don't really now anymore...I am fine, most of the time, BUT I still sometimes mull it all over and maybe always will, because I felt I was not just told teh truth, and then I start getting paranoid and wonder why....iykwim...I am just weird though, lol!

3andnomore - the point is that it wasn't scary in the slightest - she was aware that she had a chance of an emergency cs, and she didn't know about the rupture until after the birth. The cs took slightly longer than normal but she was home within 72 hours.