Saturday, June 5, 2010

To VBAC or not-to-VBAC

Vaginal birth after cesarean (VBAC) is a hot topic in the OB world right now. The June issue of Obestetrics & Gynecology has a review article attempting to determine the maternal and neonatal outcomes associated with VBAC. Their conclusion:

"Overall the best evidence suggests that VBAC is a reasonable choice for the majority of women. Adverse outcomes were rare for both elective repeat cesarean delivery and trial of labor. Definitive studies are lacking to identify patients who are at greatest risk for adverse outcomes."

Translation - we still don't know how safe/risky a VBAC is for mom and baby. I get asked for my opinion on this all of the time. I used to be all for the VBAC. I thought that I understood the benefits of avoiding repeat cesareans and that the risk of uterine rupture is there, but very rare. However, I also only have one year of clinical experience, and only six weeks of experience in ob/gyn, and really only two of those six weeks was experience on the labor and delivery floor, i.e. I haven't seen much yet. I'm not on an ob/gyn rotation currently but the other day there was a VBAC uterine rupture in the hospital where I'm working. The infant was flown to a tertiary care hospital and the prognosis was looking dim. The mom ended up in the ICU. Suddenly, my loud-mouth, inexperienced, opinion that VBACs were great and everyone should undergo a trial of labor changed. If it was my sister, would I counsel her to VBAC? Would I want to VBAC? I know that medical decisions shouldn't be made for emotional reasons, but without the evidence to back up our decision making, what do you tell a patient who asks about VBAC when you just sent the last VBAC to the ICU?


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