VBAC Case Study

Introduction
When a woman delivers in a hospital, she will do so either by vaginal delivery or Caesarean section (commonly referred to as a “C-section”). A Caesarean is considered major surgery, where the baby is delivered via abdominal incision. C-section deliveries are becoming increasingly common, from 5% of deliveries in 1970 to more than a quarter of all deliveries in 2002 (Landon, 2004). Although vaginal delivery is the natural method, Caesareans are sometimes necessary when the mother or baby cannot tolerate the stresses of labor and vaginal delivery, but the procedure is not without serious risks for complications. I began to wonder during my labor and delivery clinical rotation why it seemed to be common knowledge that women who had

In formulating the study, the researchers recognized that the proportion of women attempting a VBAC after a C-section history instead of an ERCS is declining rapidly due to concerns over safety. The researchers questioned what the respective outcomes of VBAC and ERCS are, including maternal and perinatal outcomes. They recognized that Healthy People 2010 posed a target rate of at least 37% VBACs, but they question how safe VBACs actually are due to concerns over uterine rupture as well as maternal and perinatal morbidity. This is a single study conducted over 5 years over 19 academic medical centers. The subjects included all women (45,998) with a prior history of C-section who had a single pregnancy at 20+ weeks, or whose infant’s birth weight was minimum 500 grams. Maternal and perinatal outcomes, including incidence of uterine dehiscence, uterine rupture, postpartum endometritis, and fetal death, were compared between women who underwent VBAC and women who had an ERCS without a trial of labor or emergent indications for a C-section (such as breech or transverse presentation, placenta previa, nonreassuring fetal heart tones, genital herpes, etc.). Women who presented in early labor to the hospital who eventually under went C-section were excluded from the study population. They found that women who had a history of VBAC after C-section were more likely to undergo VBAC again. The overall success rate in their population sample was 73.4%, 124 cases of uterine rupture occurred, and was significantly associated with the use of augmented labor, as compared to spontaneous labor without oxytocin use. They found that uterine rupture was associated with the greatest risk for maternal complications, but that it was unclear how often perinatal death is a result of uterine rupture. The study found no significant increase in perinatal death associated with VBAC over ERCS delivery. Ultimately, they concluded that