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VBAC Success Rates and Prediction Models: Understanding Your Chances of Important Outcomes

September 27, 2010 By A Woman's Guide to VBAC Leave a Comment

  

This article is part of A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a collection of resources that address the most common and pressing questions women may have about their birth choices. View all sections in the guide, including a link to the authors, on the index page.

 

By Pam Candelaria

 

If you are choosing VBAC, you probably have questions about how your delivery will go. You may wonder how many VBACs are successful or, perhaps more importantly, if your own planned VBAC will end in a vaginal birth. You may be concerned about whether having a lower chance of VBAC success means you have a higher chance of uterine rupture. You may be worried that you’re not an ideal VBAC candidate and wonder if planning a VBAC is still a good idea.  

The great news is that most VBACs are successful! While many factors may influence your personal chances of success, overall rates of VBAC success average 74%, and even in women who are not considered good candidates, the chance of having a vaginal birth is almost always above 50%. It is critical to remember that no single factor can tell you whether your own labor will end with a vaginal birth. Some things, like having a previous vaginal birth, either before or after your previous c-section, are very strongly associated with VBAC success; others, like your height, may not have as much impact; and still others, like the size of your baby, can simply not be known until after delivery. Because your birth can be influenced by so many things, and because those things don’t equally affect your chances of success, it is impossible to say before labor begins whether any individual woman will deliver vaginally.

In spite of this inherent uncertainty, there are many ways we can try to estimate an individual woman’s chance of VBAC success. The Vaginal Birth After Cesarean calculator developed by Grobman, et al, uses factors that are easily identified at the beginning of pregnancy and offers a statistical glimpse of potential VBAC success. One limitation of calculators like this one is their inability to account for the unique situations of individual women. For example, a previous diagnosis of cephalo-pelvic disproportion (or CPD) could be caused by a baby that is truly too big to fit through a mother’s pelvis, but it is also frequently associated with posterior (“sunny side up”) positioning, a circumstance that, unlike absolute CPD, need not reoccur (or even preclude a vaginal birth) in a future VBAC attempt. Some maternal illnesses like gestational diabetes can be controlled for some women, potentially reducing any negative impact on a planned VBAC.

You should always discuss what factors may affect your planned VBAC in detail with your provider. A careful review of your unique history is the best way to determine your personal chance of a successful TOL.

Even if you have factors associated with lower rates of VBAC success, remember that an unsuccessful TOL does not mean you will experience uterine rupture! With a single previous low-transverse c-section, the risk of uterine rupture is less than 1% even if you are not an “ideal” VBAC candidate. And remember: if VBAC is important to you, a lower chance of success is still better than no chance of success. Prediction calculators, conversations with care providers, and doing your own research are all valuable, but fallible. The only true way to know if you can VBAC is to give your body, and your baby, a chance to try.

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A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations

September 7, 2010 By A Woman's Guide to VBAC 2 Comments

 

In June 2010, a National Institutes of Health (NIH) panel published a Consensus Development Conference Statement on vaginal birth after cesarean (VBAC).

In addition to examining the current evidence related to VBAC and offering recommendations for future research on this topic, the NIH panel concluded that VBAC was a “reasonable option” for most women with a previous cesarean section.

In the context of a current birth climate that can be somewhat hostile toward VBAC, this was an exciting moment for many birth advocates, maternity care providers, and mothers!

But even with all that is included in the NIH Statement on VBAC, it might be difficult for many of us to wade through the information in it and figure out what it means for us and our particular birth options and unique circumstances.

This is where the Guide comes into play.

A group of maternity care experts and VBAC advocates came together to create A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a free online resource guide that addresses the most common and pressing questions women may have about their birth choices in what could be called the “post-NIH-Consensus-Recommendations Era.” We hope the Guide gives you the tools you need to empower yourself to advocate for you, your baby, and your birth choices!

 

Sections in A Woman’s Guide to VBAC:

 

The Inspiration for this Project

The concept for this guide was borne out of many things: the timeliness of the NIH panel’s statement on VBAC, the importance of the statement itself, and our personal interest in advocating for women seeking vaginal birth after cesarean.

But we would be remiss if we didn’t acknowledge another source of my inspiration for this project: namely, the heartfelt and heartening consumer participation in the NIH Consensus Development Conference on Vaginal Birth After Cesarean.

As women who were lucky enough to attend the NIH Consensus Conference on VBAC in person (Kristen) or view the entire proceedings in real time by webcast (Amy), we can say with some certainty that consumers – that is, the mothers, doulas, midwives, nurses, doctors, and other birth advocates who traveled from near and far and volunteered their time to attend—played a big role in this conference!

We listened, we read, we talked with one another, we got the word out to women who couldn’t participate in the meeting, and we asked some of the most incisive questions of the entire conference proceedings.

Quite simply, we made a difference.

This guide is dedicated to those consumers—and to all of us who are maternity care consumers, whether we are currently pregnant, have been pregnant, or simply work and advocate on behalf of pregnant women.
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What exactly is a National Institutes of Health Consensus Development Statement?

This statement is the product of an NIH Consensus Development Conference. These two-and-a-half day conferences—which are free and open to the public—are organized by the NIH to address issues in medicine that are both controversial and pertinent to health care providers and the general public.

During the NIH Consensus Development Conference on VBAC, an independent panel listened to presentations given by invited expert speakers. The panel also heard input from members of the general public during Q&A sessions. Finally, drawing upon the conference proceedings and upon a systematic review of the evidence on VBAC, the panel drafted their statement on VBAC.

Like all Consensus Development Statements, the statement on VBAC is not legally binding. It does not create practice guidelines, nor does it establish any health policies. Nonetheless, it is still an exceedingly important document. In fact, because of the high-quality evidence that the NIH panel uses to create consensus development statements, the NIH claims that it is “reasonable to expect that the panel will be able to give clinical guidance” to care providers.

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Coming Soon on the Blog: A Woman’s Guide to VBAC

August 30, 2010 By Cara Terreri 5 Comments

Even with all of the information that is included in the recent National Institutes of Health (NIH) statement on VBAC, which says that VBAC is a “reasonable option” for most women with a previous cesarean section, it might be difficult for many of us to wade through the information and figure out what it means for us and our particular birth options and unique circumstances.

To address these concerns, Lamaze along with a team of midwives, obstetric research experts, mothers, doulas, lawyers, and healthy birth and maternity care advocates developed A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations. The Guide, which will launch next week right here on Giving Birth with Confidence, will cover: 

  • What all of the technical terms in the statement actually mean
  • How to analyze the risks and benefits of VBAC and repeat cesarean delivery
  • Putting the risk of uterine rupture into perspective
  • Contacting your local hospital to find out their VBAC rates and policies
  • Advice on how to discuss the NIH Statement and its recommendations with your care provider
  • Other questions about the NIH Statement on VBAC

A Woman’s Guide to VBAC may be just what you need to empower yourself to be an advocate for you, your baby, and your birth choices!

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Preparing for Natural Childbirth — First or Second Time

June 2, 2010 By Danielle Elwood Leave a Comment

I looked at my second pregnancy as a “do over“ for the surgical birth of my first. I truly wanted an unmedicated, natural Vaginal Birth after Cesarean, also known as VBAC. I didn’t realized how much research I would put into my second pregnancy. Looking back on all the information I put together, learned, and came across, it would be foolish not to share with others. I think a lot of the efforts and education I put into my second child’s pregnancy and birth has been very helpful in my journey to becoming a childbirth educator.


I worked my own experience into small steps all pregnant women, or women considering trying to conceive, should read before birth.

  1. Interview Providers – Most women I have come across usually choose the OB their sister used, or even a simple referral from their insurance provider. With my first pregnancy, that is exactly what I did. By the end of my pregnancy, and after my birth, I knew the provider choice was a mistake. Providers can make or break your experience. Choose wisely.
  2. Find a Chiropractor – Most women think, “What the heck do I need a Chiropractor for?” without knowing the ins and outs of how your pelvis works!  Not only can Chiropractic Care help with pain, and discomfort, but it can help prepare your pelvis for a successful vaginal birth!
  3. Take a Childbirth Education Class - New studies show women who take a childbirth education course not only are better prepared for class, but they are less likely to be subjected to routine or unnecessary interventions in the hospital. Skip the classes hospitals offer in one day, most teach you how to be a good patient in their facility, rather than anything about childbirth. Lamaze is a great course that is not too long, and provides great education, and positive thinking surrounding birth.
  4. Hire a Doula! – Several North American studies have shown many benefits to having a birth doula. From lowering your chance from a cesarean, to shorter labor times.  There was an amazing difference in my two birth experiences, one including a doula, and one without.
  5. Check Out Your Local Hospital Statistics – Some states such as New York and Massachusetts publish the maternity care statistics by hospital, which is also required by law in these states. Unfortunately for women in other areas of the country, these numbers may not be as easily accessible, but local health departments and The Birth Survey can help you with this.
  6. Do Your Reading! – There are so many great childbirth books that can help you to focus on your journey to a natural childbirth experience.  Some of my favorites, and the most popular books include :        
    • The Thinking Woman’s Guide to a Better Birth – Henci Goer
    • Birthing From Within – Pam England
    • Gentle Birth Choices – Barbara Harper
    • Creating Your Birth Plan – Marsden Wagner
    • Ina May’s Guide to Childbirth – Ina May Gaskin
    • The Official Lamaze Guide – Judith Lothian & Charlotte DeVries
    • The Birth Partner – Penny Simkin
    • Birth The Surprising History of How We are Born – Tina Cassidy
    • Check out the ICAN Recommended Reading List also!

    What are your favorite pregnancy and birth books? Leave a comment to let other moms know about your favorite reading resources.

  7. Go internet shopping!  I get that term from the lovely Feminist Breeder, the term was something her provider hit her with when she discussed her own research she had done regarding VBAC.  Go online, and do your reading, there is so much amazing information on the internet that can help you in the right direction for starting a journey to natural childbirth. Some of my favorite online resources include :

    What are your favorite websites for natural childbirth, or preparing for birth?

These are simple steps that can’t all be done overnight, but they are basic steps in the right direction, many of which you can even start before getting pregnant.  The biggest key in having a successful and positive birth experience starts with education!

Filed Under All Recent Articles, Birth, Birth plans, Childbirth education, Choosing a care provider, Health and well-being, Pregnancy, Preparing for VBAC, Working with a doula, Working with a midwife Tagged With birth center, birth plan, care provider, childbirth class, doula, interventions, natural birth, Pregnancy, questions

Birth Transforms in Unexpected Ways

May 24, 2010 By Danielle Elwood 6 Comments

Meet Danielle Elwood, one of the Giving Birth with Confidence writers. Danielle will be sharing stories from her own two experiences in pregnancy, birth and parenting, as well as her journey to become a Lamaze Certified Childbirth Educator. Danielle also is a blogger at Momotics.

My journey began almost three years ago when I got pregnant with my first child. Of course, like most twenty somethings I thought I knew it all, and even assumed I had an extra edge over most because of my experience as a doula. I went through my whole pregnancy with an obstetrician who insisted I was high risk because of previous surgery I had in my teen years.

A month before my oldest son, Camden was born, my husband’s younger brother passed away very unexpectedly. It sent our whole family into a huge crisis, which I don’t think my pregnancy recovered from. From November 11 til December 11, I lost a notable amount of weight, and started to not be able to keep any real meals down. My OB suggested induction, and I went along with it because of course it seemed to be for the “safety” of my son.

I wish I could go back to that moment and switch OBs before I had to deal with that, and I wish I never consented to the induction. I had virtually no idea what I was getting myself into. Only seven short hours into my induction, my OB booked an operating room, because she insisted I would “never had this baby” or progress anymore than I had. I was devastated, but I did not feel as though I had an actual option. It was never presented to me as a question, or even an option to consent to, I was virtually told this was going to happen at 4:30. Had I known more about informed consent, I know it would have been a different situation. I had an unnecessary c-section just in time for my OB to go home for dinner.

When my child was eight months old I got pregnant with my second son Benjamin. I knew I wanted to do everything differently. I interviewed several local midwives and doulas and made my decision very carefully. I knew VBAC was my only option, and I charged full speed ahead. My second pregnancy was nothing like my first. I was not considered high risk and I was not treated like I was sick or ill. I was just pregnant, woman with child, growing my child to bring into the world when he was ready. He decided that on May 16, 2009 he was ready, and I went into labor on my own while manning a booth for my local ICAN chapter.
After laboring for over 26 hours, and a very stuck little boy, I had a second cesarean section that not only saved my son’s life, but also saved my own. (You can read more details about Ben’s birth here.)

I had the experience of both sides of the table – the unnecessary surgical delivery and one that was necessary. But something new clicked in me. A need to help others on a deeper level. Not too long after starting to look into becoming a birth professional on another level, I came across an article about the serious need for childbirth education in our society today, and the gross misconceptions about pregnancy and birth.  I knew right then and there that childbirth education was the field I needed to move toward.

With the help of several friends in the birth community, and after weighing out all of my options for certification, I decided to take a Lamaze workshop. I am excited to be bringing Lamaze into my community, as there aren’t many local teachers, and I feel as though I identify the most with Lamaze when it comes to their philosophy on childbirth.

I am really excited to have the opportunity to write for Giving Birth with Confidence, and help my own journey to help other mothers, as that is what my calling is now.

Filed Under All Recent Articles, Birth, Birth stories, Preparing for VBAC, Working with a doula
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