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Make an informed choice about the risks of repeat cesareans Vs. VBAC.

Cesarean sections are major abdominal surgery, and like all surgery, carry the risks of complications. These can include dense adhesion's, excessive scar tissue growth that connects the uterus to surrounding tissues and organs. Adhesion's can increase the risk of longer operation times and injury to adjacent organs. The risk of hysterectomy, or the surgical removal of the uterus, also rises. Undergoing repeated cesareans make it more likely a woman will experience placenta accreta,  in which the placenta grows into the middle layer of the uterus, possibly causing hemorrhage and requiring a hysterectomy.

A woman who has repeat cesareans can also be more likely to experience thromboebolisms (blood clots that break lose and block vessels), or experience blood loss. And while uterine rupture (a rare but potentially catastrophic event during pregnancy or childbirth in which the uterine wall splits open) remains a concern after one or more cesareans, the risk of uterine rupture is small, and it decreases further with each additional VBAC.

Lets Look at the numbers....

1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)

1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion's : 21.6% (1 in 5)

2nd VBAC
Chance of Successful VBAC : 87.6% (9 in 10)
Risk of Uterine Rupture : 0.45% (1 in 222)
Risk of Hysterectomy : 0.17% (1 in 588)
Risk of Blood Transfusion : 1.24% (1 in 81)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion's : 32.2% (1 in 3)

3rd VBAC
Chance of Successful VBAC : 90.9% (9 in 10)
Risk of Uterine Rupture : 0.38% (1 in 263)
Risk of Hysterectomy : 0.06% (1 in 1667)
Risk of Blood Transfusion : 0.99% (1 in 101)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in 8)
Risk of Dense Adhesion's : 42.2% (2 in 5)

Note : "Major complications" include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.

Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.

Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveres. Obstetrics & Gynecology 2006; 108: 21-6

All VBAC statistics for this are taken from the Mercer & Gilbert study in which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates.

Thank you to ICAN for this wonderful information.

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Oct. 19, 2009 at 1:24 PM

I find this very interesting thanks for sharing this information. I myself have had 3 c sections .. I had no choice for I didn't dilate with any of my children. If you have a choice it is good to go with the Vback your are right though with a vback there are risks as well due to scare tissue from the c section you have had before. This was not only told me to before I had 2 other csections but to many others. So sometimes vbacs are discourage. Again thanks though It is something others should know about.

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Oct. 19, 2009 at 1:31 PM

I've said it before -- I'll say it again: A repeat, scheduled, ELECTIVE Csection SAVEd my child's life & saved mine.

There was no real medical reason to choose a Csection - my dr. just thought it best. Good thing, too, because when she opened me up that morning she found that I'd already begun to rupture on my previous uterine incision.  I'd been in full blown labor for quite some time and didn't know it -- didn't feel the contractions... didn't feel the rupture because of the scar tissue left behind by the 1st Csection.

Had I not had my cesarean scheduled for that day, I would have continued to labor & continued to rupture until it got so bad that I finally felt it... and by then, it would've been too late.

Yes -- make an INFORMED decision --- get experiences from both sides.  If I'd listened to the statistics and all the "you don't need a Csection, YOU CAN do it!!  It's natural..." moms, I'd be a post-hysterectomy mom (if I'd lived) of 3  - 2 living & 1 deceased -  instead of a healthy mom of 4 healthy kids.

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Oct. 19, 2009 at 1:34 PM

Laura, there is no need to get defensive, this is simply information.

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Oct. 19, 2009 at 5:38 PM

Sadly only my 4th c-section was actually medically needed.  Impatient doctors, and me not knowing my rights were my downfall.  My 4th was stillborn, and breech.  It was the only one that actually needed to be done.

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Oct. 19, 2009 at 9:57 PM

I am 4 days late and I want to be induced so many have told me that I shouldn't get induced because it's risky but I feel its ALOT better than having a csecton. actually I could still have to have a c section even if I dont' get induced since I carry large babies.

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Oct. 20, 2009 at 11:54 AM

I had an emergency c-section with Hailie after being in labor for four days, my cervix just would not dialate. Well since this happened I am not a canidate for a vbac because of other complications. Had I have know the risks of being induced with my first daughter, I might have had a normal vaginal birth. While at least I know what to expect with this c-section due to be done in April.  I am so glad someone is willing to do the homework on the pros and cons of VBAC & C-sections.

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Oct. 20, 2009 at 1:41 PM

Very interesting.

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Oct. 20, 2009 at 4:34 PM

great info, thanks for posting. i had a VBAC in April 08. my sister just had a c/s with her first, i am hoping if she has more kids she will look into VBACs like i did.

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Oct. 20, 2009 at 4:46 PM

This is a great journal! All too many times women are pressured to do a repeat c/s by their doctor and never even do the research about how much safer it is to VBAC.  I had a c/s with my first and I tried to VBAC with my second but it didn't work out.  I had an all natural VBA2C with my 3rd because even after 2 CS I felt it was the safest thing to do for my child and myself. I was amazed at how great I felt afterwards, both physically and emotionally!

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Oct. 20, 2009 at 4:49 PM

I don't think Laura is being defensive, I think she is telling it like it is. For her the elective C-section saved her and her child's life. She got lucky. I had a C-section with my son and if I do have another child I will have another C-section, not because I elect to but because with my health it would be best for me and baby to. Unfortunately not every woman has a choice.

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