A successful VBAC, or vaginal birth after cesarean, is beneficial for both the mother and the child. Fewer complications are present after birth for the mother and the child. Through vaginal delivery, the infant is also provided with good bacteria, making the child less vulnerable to illness. Additionally, new advances in medical science have made it more possible than ever to achieve a successful VBAC.
Despite these facts, cesarean births have been on the rise for the last 20 years. And, according to Christine Catling-Paul, the lead author in a recent study, “many women who have had cesarean sections opt for the same procedure with their next pregnancy.” Based on this information, researchers from the Faculty of Nursing, Midwifery and Health at the University of Technology, Sydney, New South Wales, Australia have been looking for a way to help reduce the numbers, hoping to find a cause for the large number of women that have subsequent cesarean births.
To help them in their studies, researchers looked at more than 24 years of data that included more than 700,000 women in 13 different countries. They found that only 33% of women in the UK are likely to have a VBAC. In Australia, the rate is substantially lower, a staggering 17%. One positive finding, however, is that 73% of American cesarean births are likely to be VBACs during subsequent pregnancies.
In addition to the statistics mentioned, researchers revealed that there are both clinical and non-clinical factors that affected whether or not a VBAC is attempted and how likely the chances are that the attempt will be a success.
Non-clinical findings included:
- The type of information provided to women about cesareans.
- The physician’s attitude towards cesarean birth.
- Local guidelines.
Clinical findings included:
- Labor induction methods, including artificial membrane rupture, oxytocin infusion and prostaglandins reduce the chances of a successful VBAC attempt.
- VBAC rates are lower in women that have X-ray pelvimetry.
- Cervical ripening agents reduce chances of a successful VBAC.
- Scoring systems used to predict VBAC success are unreliable.
The findings outlined in this study point to a need for more education about the benefits of VBACs for women, physicians, hospitals and clinics. Hospitals, clinics and physicians should also be educated on how to make VBACs more successful.
A few recommendations outlined by the researchers included:
- Further research to help decrease the number of cesareans, particularly in women that have had a previous cesarean.
- Implementation of evidence-based local guidelines to increase VBAC rates.
- Increased decisional aides to help women make a more educated decision about their birth plans.
- Avoidance of scoring systems and X-ray pelvimetry to predict VBAC success potential.
- Caution on the part of the clinician concerning induction or augmentation of women that have had a cesarean previously.
Cesarean births will probably never be completely eliminated, no matter how much effort and research is done. However, by using and implementing these guidelines, clinicians may be able to perpetuate a motion that reduces cesarean rates worldwide. In doing so, they will provide health benefits to both mother and child.
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