Nearly one-third (32%) of all births in 20007 were cesarean sections, the highest reported rate ever in the US(Contemporary OB GYN , May 1, 2010).
Last year a panel organized by the National Institutes of Health in March 2010 recommeded that Vaginal Birth After Cesarean (VBAC) be considered on a case by case basis in women who have discussed the issue with their physicians (Nurse-Midwives) and are aware of the benefits and risks with the two types of deliveries. The risk of uterine rupture is low, at less than 1%. Since 1996 the rate of VBAC has decreased to less than 10% in the US. Various surveys have shown that since 1996, approximately 1/3 of hospitals and 1/2 of physicians no longer offer trial of labor(TOL) for women with a history of cesarean section deliveries regardless of prior vaginal delivery experience. Concerns over liability risk have a major impact on the willingness of physicians and health care institutions to offer trial of labor. Benefits to mother of VBAC include a shorter recovery period, less likelihood of blood loss, infection, damage to internal organs and less likelihood of respiratory distress after delivery in the infant.
That being said, I had the perfect candidate for VBAC recently. This mother (and her husband) loves her babies and grown children from ages 3 to 21 with a passion and room for yet another child to love. Being a mature grand multipara ( greater than 5 pregnancies...9 to be exact), she had successfully had 6 vaginal births, then infant #7 had to be an emergency C/S due to a partial abruption ( placenta pulling away form the uterus) during labor.
As 39 weeks came to fulfillment, her body was agreeing with yet another vaginal birth, but could the dots be connected for the hospital, antibiotics to prevent a possible infection in the newborn, low dose Pitocin, the Nurse-Midwife for support and the physician who would agree to remain in house during the trial of labor for the anticipated vaginal birth after cesarean (VBAC)? Ecclesiastes 3:1,2a "To everything there is a season, A time for every purpose under heaven: a time to be born"...
Several phone calls later, the hospital was selected ("Thank you Women's East"), the physician had agreed to come in house for the induction and trial of labor, the spouse and children had been notified, and mom, dad, and two of the big sisters were on the way to the hospital. When the on-call physician came into the room to meet the patient she thanked him so much and said "I have worried all during my pregnancy, would any one be willing to come and sit with me so I could do this?" The physician beamed at this mother's appreciation of his time in her behalf.
With the safety nets of IV access, low dose Pitocin drip, PCN, and electronic fetal heart rate monitoring, the evening moved on. Slowly but surely the body remembered what it had done so efficiently six times before. Fetal heart tones remained reassuring as long as mom stayed in a semi-fowler's position. One big sister who had college exams the next day kept in touch by phone or Skype. Mom enjoyed the loving support of her husband and two daughters during the not quite time for my epidural period and while waiting for labor to complete the task of dilating her cervix to 10 centimeters.
