Ep 30: All About VBACs

Birth Kweens

In this episode of Birth Kweens, Karly and Ali take a deep dive into the hot topic of VBACs (vaginal birth after cesarean). There’s a lot of misinformation floating around about VBACs, but lucky for you the kweens are here to clear things up with lots of evidence-based information and practical insight! Here’s an overview of what’s covered in this episode:

• What it means to have a VBAC and why they’re such a hot topic in the birth world
• The most recent data on the cesarean rate in the USA
• Evidence on the optimal cesarean rate (i.e. the amount of cesareans we should be doing to optimize maternal and infant health outcomes)
• The reasons someone might want to have a VBAC
• Who’s a good candidate for a VBAC
  • According to ACOG and the NIH, VBAC is a “safe, reasonable, and appropriate option for most women with one prior cesarean and some women with two prior cesareans”.
  • According to the NIH VBAC Consensus Statement, approx. 74% of women who plan a VBAC will have one, but success rates vary from 54-94% depending on various factors.
• Who isn’t a great candidate for a VBAC
• What it means to have a “special scar” on your uterus and a great resource for those who do
• The risks of a cesarean for both mom and baby
• The benefits of an elective repeat cesarean
• Henci Goer’s analysis on whether an elective repeat cesarean is truly safer than a planned VBAC
• The benefits of a VBAC/TOLAC
• The risks of a VBAC/TOLAC (including lots of info about the big one – UTERINE RUPTURE!)
• Specific resources and studies regarding uterine rupture…
  • What it means to experience a uterine rupture and why the risk is higher with a VBAC than with a planned repeat cesarean
  • The difference between a uterine rupture and a dehiscence (source: https://reference.medscape.com/article/275854-overview)
  • The odds of experiencing a uterine rupture during a TOLAC/VBAC range from 0.21-0.9% depending on various factors (sources: https://www.ncbi.nlm.nih.gov/pubmed/15598960, https://www.ncbi.nlm.nih.gov/pubmed/22427745?dopt=Citation)
  • To further put the risk of uterine rupture into perspective, the authors of this well-respected book on obstetrical practice guidelines comment, "To put these rates into perspective, the probability of requiring an emergency cesarean section for acute other conditions (fetal distress, cord prolapse, or antepartum hemorrhage) in any woman giving birth, is approximately 2.7%, or up to 30 times as high as the risk of uterine rupture with a planned vaginal birth after cesarean." (source: http://www.homebirth.org.uk/vbacur.htm)
  • And for even more perspective on the relative risk of uterine rupture with a TOLAC/VBAC, refer back to Henci Goer’s thorough analysis on the topic
  • January Harshe’s analysis on the safety of VBACs
  • The signs and symptoms of uterine rupture
  • The factors that impact the rate of uterine rupture, including the thickness of the uterine scar at the end of pregnancy
• How to decide if a TOLAC/VBAC is right for you
  • The calculator to predict VBAC success
  • A great article that maps out the pros and cons of a VBAC vs. planned repeat cesarean
• The factors that influence the success of a TOLAC/VBA
• The pros and cons of planning a TOLAC/VBAC at a hospital vs. a birth center vs. home birt
• VBAC resources:
  • VBAC Facts
  • ICAN (Find a local chapter!)
  • VBAC.com
  • Check for VBAC support groups online (especially on FB)
• Books on VBACs:
  • Give Birth A Chance: How to Prepare for an Empowered VBAC by Ilia Blandina
  • The VBAC Companion by Diana Korte
  • Birthing Normally After a Cesarean or Two by Helene Vadeboncouer
  • Cut, Stapled & Mended by Roanna Rosewood
  • Ina May’s Guide to Childbirth by Ina May Gaskin
  • Birthing From Within by Pam England & Rob Horowitz

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