For women who previously had a cesarean birth, deciding whether to have an elective repeat C-section or attempt a VBAC isn't always a simple choice. But a new study suggests the risks of complications posed by either option are relatively low and comparable—or even favorable for mothers and babies if a VBAC is successful.
The caveat is there are many factors at play that can predict the success of an attempted VBAC, so the decision is best left to individuals working under the guidance of their own healthcare professionals.
According to the study published in the Canadian Medical Association Journal (CMAJ), there is a slightly high risk of complications associated with attempted VBACs (with complications occurring in 11 in 1,000 deliveries) versus scheduled C-sections (complications in 6 in 1,000 deliveries). The researchers attribute this largely to the fact that approximately 50% of attempted VBACs result in emergency C-sections.
However, for women with successful vaginal births after a previous C-section, the overall rates of complications were lower than if they had a second C-section. The researchers also note VBACs may be desirable for women who plan to have more children as it is unlikely for a woman to have a successful VBAC after two or more C-sections.
"What we want people to take away from this is that when patients are properly selected and managed safely in labor and delivery, both options are reasonable and low risk," co-author Carmen Young, an assistant clinical professor in the University of Alberta's department of obstetrics and gynecology, tells The Globe and Mail.
For the study, researchers analyzed 2003 to 2015 data from all women in Canada (excluding Quebec) who had a second child after first having a C-section. Noted complications associated with attempted VBACs include uterine rupture and hemorrhage while complications associated with C-sections include surgical complications and placental complications in subsequent pregnancies. The authors say they were surprised to see that infant, but not maternal, outcomes worsened between 2003 and 2015 as a result of attempted VBACs.
The researchers also challenge the rising overall rates of C-section deliveries. The World Health Organization says the ideal rate of C-sections worldwide should be between 10 and 15%, yet it is closer to 32% in the United States and approximately 26% in Canada. "This topic is an important issue because rates of cesarean section continue to rise and the most common single indication for a cesarean delivery is a prior cesarean delivery," says Young in a press release.
For mothers deciding between an elective C-section or attempted VBAC, the authors note there are many factors to consider—including the reasoning behind the initial C-section and future family plans. "Because the choice between delivery modes is so personal, it's up to clients to evaluate and interpret the risks," says Young. "Our research highlights the importance of appropriate patient selection as well as the importance of careful monitoring in labor and delivery to optimize their safety."