Friday, February 12, 2010

Do we need to revisit VBAC guidelines for women with three or more prior caesareans?

New research, soon to be published in BJOG, opens the question of VBACs for women who have had multiple cesareans. The study compared the morbidity rates of planned VBAC after three cesareans, against a planned repeat cesarean. The results? No real difference. There are morbidity risks associated with VBA3C, of course, but these are not greater than the morbidity risks associated with multiple cesareans. Read the full release here.

According to the lead author, Dr. Alison Cahill, from the Department of Obstetrics and Gynaecology at Washington University in St. Louis School of Medicine:
“These data suggest that women with three or more prior caesareans who attempt VBAC have similar rates of success and risk for maternal morbidity as those with one or two prior caesareans, and along with other publications, suggest that perhaps it is time to revisit the current recommendations for VBAC attempts for women with more than one prior caesarean”.
With the burgeoning number of women with multiple cesareans, some of whom will want to have more children, this kind of research is extremely important.

4 comments:

Amie said...

One statistic that interests me in this is that IF something does "go wrong" with prior cesareans the increased likelihood for that occurrence becoming fatal is greatly increased (or so I've been told). So while your percentage of uterine tear does not increase statistically significantly with each cesarean your risk for a uterine tear becoming fatal to mother and child do (does this make sense). As someone who has tried to VBAC and been unable to and desires more children after 3 Csections this topic greatly interests me :-)

Emily (Laundry and Lullabies) said...

Amie, I'm interested in that statistic. Do you know what study that is found in? I'd like to read up on it.

Amie said...

I was actually hoping you would know :-) I cannot remember where it was found but my Dr. was discussing it with me before. He is pretty pro-Vbac until 3 then he says the risks outweigh the benefits, statistically there is no difference UNTIL something goes wrong. We found it facinating...I am going to try and dig it up let me know if you hear anything about it...intuitively it makes sense...lots of cuts does weaken the muscles so a tear could in theory tear faster...hmmm just curious!

Emily (Laundry and Lullabies) said...

Amie,
I spent nearly an hour digging tonight, and couldn't find anything like what your doctor says. Would you ask him what study he is referring to? I would REALLY like to read it.

What I did find, for those who are interested:

http://vbacfacts.com/2009/08/03/maternal-morbidity-associated-with-multiple-repeat-cesarean-deliveries/

http://findarticles.com/p/articles/mi_m0CYD/is_6_40/ai_n13598790/

http://www.plus-size-pregnancy.org/CSANDVBAC/vbac_after_2_cs.htm#VBAC%20After%203%20or%20More%20Cesareans

From everything I've read, Amie, more cesareans are likely more dangerous for you than a VBAC.