VBAC safer for baby than elective repeat caesarean

For further information about VBAC and birth options, contact Melissa Maimann at Essential Birth Consulting. Article

[Elective repeat caesarean] doubles odds for intensive care compared to vaginal birth newborns, researchers say.

Babies delivered by elective, repeat cesarean section delivery are nearly twice as likely to be admitted to the neonatal intensive care unit (NICU) than those born vaginally after the mother has previously had a c-section [VBAC], a new study finds.

These c-section babies are also more likely to have breathing problems requiring supplemental oxygen, the researchers say.

"In addition, the cost of the birth for both mother and infant was more expensive in the elective repeat c-section group compared to the vaginal birth after c-section (VBAC) group," ...

... Nationwide, the c-section delivery rate keeps rising. According to the study authors, by 2006, 31.1 percent of deliveries in the United States were done this way.

Australia's caesarean rate was 31% in 2006, and our national VBAC rate was 16.5%. In NSW hospital VBAC rates can be as low as 2%.

Furthermore, women who have delivered once by c-section have a greater than 90 percent chance of undergoing another, the authors noted. But experts continue to debate whether these women should try labor and vaginal delivery, or automatically undergo another c-section, as there are risks are associated with each method.

... Kamath and her colleagues turned to records from the perinatal database at the University of Colorado Denver. Those records ran from late 2005 through mid-2008 and focused on babies born to 343 women who had planned a repeat, elective c-section and another 329 who planned to try vaginal birth after having previously had a baby via c-section.

The researchers looked at the differences between groups in newborn admissions to the neonatal ICU and the need for oxygen for breathing problems, as well as cost differences.

Kamath's team further divided the women into four groups. Of the 343 repeat c-sections, 104 went into labor before the c-section and 239 did not. Of the 329 women who attempted vaginal delivery, 85 failed ... and went on to have a c-section.

Kamath's team found that 9.3 percent of the c-section babies were admitted to the NICU, but just 4.9 percent of the vaginally delivered babies were. And while 41.5 percent of the c-section babies required oxygen in the delivery room, 23.2 percent of the vaginally delivered babies did. After NICU admission, 5.8 percent of the c-section babies needed the oxygen compared to 2.4 percent of the vaginally delivered babies.

The median hospital stay was three days for babies who were delivered vaginally and four days for the other three groups ...

"The failed VBAC babies required the most resuscitation and had the most expensive total birth experience," Kamath concluded. But, overall, the VBAC group did better than the c-section group ...

Women who opt for a repeat c-section should first understand these risks and differences before they make their decision, Kamath said.

The study results suggest another important take-home point ... "The decision to have your first c-section is very important," he said. "There should be a clear medical indication [because] your first may dictate subsequent [delivery methods]."

Women also need to know that vaginal delivery is possible for many women who have already undergone a c-section, Fleischman said. Some hospitals do not allow vaginal delivery after a prior c-section, however, so he suggested that any woman who is planning on one find out early on what her hospital's policy is.

If you are planning a hospital VBAC, employ the services of a private midwife to advocate for you and provide support and advice. Australia's hospital VBAC success rate is very low, however homebirth (private) midwives have a high VBAC success rate - some as high as 90%. By taking a private midwife with you to hospital, you can benefit from the high success rate while also being in your chosen birth environment.

Melissa Maimann, Essential Birth Consulting 0400 418 448