Benefits of Vaginal Birth after Cesarean

Although most expectant mothers can go through a successful vaginal birth after cesarean (VBAC) without difficulties, there is often the risk that the incision from the previous operation could rupture the uterus. Nonetheless, in such cases, effective medical teams can alleviate the risk through electronic monitoring of the fetus. While the trial of labor after a cesarean birth (TOLAC) is a time-honored practice, the safety of VBAC remains questionable because of the dwindling numbers of women attempting VBAC. However, irrespective of the visible dangers, TOLAC has not only been the best option for women but has also led to promising outcomes in the majority of the cases. On the contrary, repeated elective cesarean has been with challenges as well. The paper demonstrates that most women can have successful VBAC.

Summary

While cesarean delivery has been on a high increase in the recent times than it was the case previously, the safety of VBAC has attracted a raging debate. Most women that had C-section previously have been successful candidates of virginal birth, especially when they do not develop complications. It is nonetheless an intricate affair to try and envisage with any certainty if a pregnant mother can have a successful virginal delivery or have yet another C-section. However, it may be highly unlikely for an expectant mother that had no issue with dilation but was unable to push leading into a C-section. An effective VBAC enables an expectant mother to preclude core abdominal operation and risks.

Since C-section is risky, vaginal delivery if a suitable option. Women who undergo virginal delivery prevent major surgeries and related risks including infections, pain severe bleeding, and scarring. VBAC is beneficial when it comes to prevention of severe adnominal surgeries, which are risky. For instance, the surgeries can harm other body organs, bowel complications, and diseases particularly anemia. Nonetheless, there is a considerable increase in C-section cases due to uninformed choices. The majority of women lack the necessary information on the effective delivery method. Even though VBAC is the best delivery method, it is considerably risky. However, the likelihood of these risks is small particularly among healthy women and with no other health complications.

Again, the risks associated with VBAC can be reduced if pregnant women consult with health providers prior to choosing the mode of delivery. Many women go C-section since they fear labor; analgesia and anesthesia can be used to relieve labor pain. Policies that restrict women to a certain mode of delivery must be outlawed. Instead, they should be allowed to decide the preferred method. It is clear that VBAC is the effective method of delivery while women can naturally deliver regardless of previous cesareans. This will not only increase life expectancy but also ensure safe delivery for the mother and the newborn.

Introduction

Recently, a debate has emerged on the safety of vaginal birth after a cesarean delivery where different conclusions have been reached according to the views and understanding of various people. A field research carried out in 2007 revealed that the rate of cesarean delivery had risen tremendously to over 31 % compared to a previous study done in 1970 that showed that only 5% of the birth cases were reported to be cesarean. Before this, the acceptable delivery method was to precede a cesarean after another cesarean which eventually changed after successful VBACs cases. Women then adopted this as the acceptable and reasonable method of delivery which caused the percentage of VBACs to rise from the previous 5% to around 28% around 1985. Nevertheless, this rise came to a halt in around 1996, and since that time VBACs started to decline up to an estimated percentage of 8.5% in 2006(American Academy of Family Physicians, 2015).

The significant decrease came as a result of some factors, one of them being restrictions from the hospitals. Some hospitals felt that VBACs posed a high risk that could lead to loss of life and therefore prohibited it. Insurance companies were opposed to covering it highlighting the underlying risks. Most individuals also felt that it was the right thing to precede a cesarean with another cesarean after assessment of both risks and benefits(The American congress of obstetricians and gynecologists, 2010). The choice, however, was based on the health of the patients and the success of the cesarean process they have had because VBACs would pose more threat to patients with complications which arose during the cesarean delivery or other health problems like diabetes. ERCD was also popular because despite it being more expensive than VBAC, it portrayed minimal risks such as uterine rupture (Madhavi, Micog, Sapna, Lavanjq, & Sushma, 2013).

However, VBAC applies to all mothers whenever they meet the standards of such delivery. Moreover, if issues that led to C-section delivery were well managed, then the risks are highly minimized. The aim of this paper is to show that patients (pregnant mothers) who are less prone to diseases and conditions are suitable candidates for the VBAC. The essay reviews the various scholarly arguments and articles concerning VBAC and why it should/should not be applied during delivery. However, the primary issue discussed in this article is the relevance of VBAC to delivery. The group of focus, in this case, is women who are less prone to diseases or infections.

Can the benefits of VBAC outweigh the risks posed during delivery in low-risk patients? While there exist different ways through which children are born, the dominant methods include vaginal birth or surgical delivery through caesarean section. In both cases, the ultimate goal is always to ensure that children are born safely. A C-section occurs as a result of prior planning. Planning, in this instance, is essential since it is influenced by unavoidable circumstances.

For example, mothers with twins or triplets could be informed in advanced that they can only deliver through caesarean because their conditions do not favor the natural birth. In most cases, C-section is recommended to high and moderate risk patients; those that are susceptible to diseases or conditions that would damage natural delivery. Some of these patients include mothers who experience unstable blood pressure, those who have diabetes, and some might have contracted infections such as HIV and herpes. In typical cases, pregnant women who have placenta complications are advised to deliver through C-section. Another issue that could lead to C-section delivery is the size of the baby. There are cases where the baby is larger than the pelvis of the mother.

The situation worsens when the baby is not facing upside down whereby its head is positioned upwards. In case efforts to turn the baby before birth are unsuccessful, the mother is prescribed the C-section. However, it should be known that C-sections are not always planned. The primary reason as to why they are done is mainly to protect both the health of the mother and the baby. Therefore, it is an intervention that only arises when their health is in danger. To establish this case, people ought to consider that C-section carries more risks compared to natural birth. Caesarean delivery demands opening of women's abdomen and getting the baby directly from the uterus, and therefore, the chances are high that first-time mothers who undergo this process are highly vulnerable to continuous surgeries. In comparison, patients who deliver through natural process face fewer risks associated with abdominal surgery. The common disadvantage of C-section is excessive bleeding. Women, in this case, can bleed to the point of requiring supplements or blood transfusions and sometimes hysterectomy. When such happens, the risks of developing infections and damage to vital organs are inevitable.

The practitioners cannot guarantee the safety of a woman a hundred percent due to uncertainties. The complications are deemed to be felt even more when the woman is subjected to another surgery. The procedure becomes more complicated and the scars hurt more. The worst part is that women will be required to stay in the hospitals for a longer time than that they spent in their first surgery. Sadly, the longer the wait, the more the pain since recovery is slower and uncomfortable. Parents who plan to have more children have their dreams relinquished in the event C-section delivery is advised. The chances are high that with each delivery of such kind, the placenta previa and placenta accrete will implant even deeper and will not be able to separate at delivery. The conditions thus threat the life of mothers. However, to avoid this, parents are advised to consider family planning, and hence the rate of giving birth is minimized, and mothers are often regulated and recommended to avoid pregnancies that can lead to their deaths.

Considering the disadvantages of C-section, it is clear that vaginal delivery is the best option. In this case, fewer risk patients are qualified candidates to deliver through natural birth. A mother that has no complications can start breastfeeding her baby immediately after birth. Lundgren (2012) quotes that “women who undergo virginal birth avoid major surgery and its associated risks such as severe bleeding, scarring, infections, and longer lasting pain. With this mode of delivery, a mother can start breastfeeding soon after delivery. Some benefits have been associated with VBAC, one of them being avoidance of severe abdominal surgeries.

These surgeries come with risks such as injuries to other body organs, bowel complications like constipation as a result of intestines in particular ileum, disturbances, and severe hemorrhage if not properly executed. One of the most common diseases as a consequence of the loss of blood is anemia(Mayo Clinic, 2016). It is characterized by a deficiency in hemoglobin, and that is the reason why pregnant women take iron supplements to produce hemoglobin. ERCD, therefore, increases risks of anemia due to severe loss of blood during surgeries. They can also cause some serious infections that can eventually lead to the death of the patient. Apart from the mother, the operations pose a risk also to the infant leading to more costs. There is the likelihood of an injury during birth that may result in the baby requiring special care at the NICU(Lundgren, 2012).

Cesarean is also expensive since the infant has to spend some time in the incubator in case the birth dates were miscalculated, unlike vaginal birth which is usually determined by the labor pains. VBAC also comes with the benefit of less time to heal when patients can take less than two days in the hospital and less than two months to recover entirely compared to cesarean which can take up to four months. VBAC also reduces future risks and complications associated with undergoing several cesarean deliveries such as placenta accrete and previa (Briggs, 2015). In another study, it was revealed that if all the qualified candidates underwent TOLAC, the instances of cesarean delivery would be minimized to around 25.5%. This study applied TOLAC calculators and models to justify its results (Metz, 2016). The study used different women demography and health to predict chances of success in VBAC. It not only revealed direct results but also determined the well-being of women (morbidity) in both methods of delivery. It showed that low maternal morbidity was shown in women who had VBAC and was high in women who had ERCD. Nevertheless, this approach did not evaluate other factors that affect a woman’s decision while choosing a delivery path. Subjecting fewer risk patients to numerous C-section is decreasing their life span.

The study suggests that women who deliver through C-section continuously are three times more likely to face death than those who use DBAC (Metz, 2016). This is as a result of the blood clot and other complications arising from anesthesia. To evaluate the effectiveness and the cost of TOLAC compared to that of cesarean after cesarean deliveries, the Markov model was used where women were selected, and studies were done on some occasions during pregnancy(Gilbert, 2013). The test was based on the probability of complications developing after both methods such as cerebral palsy and urinary incontinence. It was also based on the quality of life afterward, the costs associated, and the view of the society regarding both methods of delivery. The model also accounted for other effects such as uterine rupture probability, costs of success or failure for both approaches, and incontinence. During the study, a decision tree was formulated and probabilities obtained from the data collected. ERCD was understood as emanating from a prior cesarean only, and therefore, there was an exclusion of those who had undergone cesarean for other reasons such as placenta previa. Women who had undergone cesarean before 39 weeks of gestation were also eliminated from the test because such cases could result in complications which would likely affect the findings. Also, there was an exclusion of women with induced labor and abnormal fetus.

The study revealed that TOLAC was a suitable method than ERCD not just because of cost reduction of about $164.2 million but also the quality healthcare outcomes. While the study involved 100,000 women, the success of TOLAC was estimated to be 67.2%. The method will be preferred because of the low-risk associated with uterine rupture. The success of the uterine rupture was found to be 0.8% hence making VBAC the most preferred method. The test also revealed that out of the 100,000 women screened, 80,229 underwent a successful TOLAC. Only 271 patients exhibited complications such as placenta previa and accreted and maternal death. The conclusion was that VBAC is more efficient and cheaper than ERCD. It is estimated that 60 to 80% of VBAC candidates deliver safely(VBAC Guidelines, 2010). Nevertheless, not all women can qualify for VBAC, and therefore, the critical analysis should be done to evaluate the candidate’s chances of success. It is advisable for the tests to begin during the early stages of pregnancy during frequent clinic visitation to give time for prior preparation if the woman decides to try for labor (Armstrong, 2011).

Besides VBAC being recommended and being the usual way of delivery, it’s also associated with some risks which make cesarean more preferable among many women. All the risks associated with VBAC are most likely as a result of a failed TOLAC which makes them even more severe. VBAC should always be carried in a well-equipped hospital in case of failure leaving cesarean as the only alternative. The most common complication as a result of a failed TOLAC is a uterine rupture. This complication is, however, more common in women with hysterectomies and is mostly provoked by the previous incisions made during cesarean delivery (Lang & London, 2016). The chances of death in childbirth are minimal in either of the methods but are a bit higher in VBAC compared to elective repeat cesarean delivery(Dodd, 2013).

Recommendation

It is, therefore, important for any woman considering VBAC to consult a professional who can advise her on the risks and the benefits associated with the method. It is applicable mostly to women with a low transverse incision during their previous deliveries, and without a history of other complications. One of the impediments that may obscure a successful VBAC delivery is macrosomia. Women with large macrosomia are more likely to be unsuccessful with vaginal birth compared to those with a less macrosomia. Macrosomia is a condition whereby the newborn is bigger than the average standard size and weighs more than average, which is more than 8 pounds. Women who may have had a cesarean delivery due to dystocia are also at risk of certain complications if they attempt vaginal birth after cesarean delivery. Dystocia is usually characterized by abnormal positioning of the fetus or weak contraction and expansion of the uterus. This then makes the mother unable to push during delivery.

The use of labor induction drugs such as misoprostol in women after the eighth week of pregnancy has also been believed to increase the risks of uterus rupture (Hauk, 2015). Labor induction could be successful in women who have had a vaginal delivery before because they have a ready and favorable cervix. Mechanical methods of induction or use of oxytocin also pose a lower risk than misoprostol.

Studies on oxytocin augmentation have shown differences in response towards the drug and giving no individual basis to justify its riskiness. Doctors should, therefore, advise the patients that although labor can be induced, it also poses a high risk of unsuccessful VBAC. As such, the doctor may also recommend the best facilities for VBAC, however, in the case of an emergency cesarean delivery; the facility should be well equipped to handle the eventuality(American Academy of Pediatrics, 2012).

Conclusion

From the different studies discussed above, it can be connoted that there is a tremendous increase of cesarean cases most of which have been as a result of uninformed decisions from women. Most females make choices without enough information which affects their judgment regarding the most efficient way to deliver. Considering the cost and the effectiveness of the methods, VBAC emerges as the most superior method of delivery (Crawford, 2015). Although it comes with risks, there are minimal chances for these risks to occur especially in women who have proved to be of good health and without other complications. Moreover, risks are evident when VBAC fails, however, the chances of failure, however, can be minimized if pregnant women consult their healthcare providers early before choosing the method of delivery (Cunningham &Wells, 2015).

They are tested, and their viability for TOLAC is determined. The health providers can also advise on the best facilities for such a procedure. Most women also chose to undergo cesarean because of fear of labor. However, drugs such as analgesia and anesthesia are used to relief pain during labor without risk. Policies limiting women towards a precise method of delivery should also be illegalized (Leeman & King, 2011).

Women should personally decide on the methods for delivery. Above documentation is enough to understand that VBAC is the most efficient delivery method, and women can give birth through labor despite having undergone a cesarean. Moreover, every woman deserves to have the will and ability to dictate their delivery. However, this is not achievable if practitioners fail, misadvice and scare away pregnant women. VBAC is slowly taking charge over caesarean and thus needs to be encouraged so that people can embrace it. Through such measures, life expectancy will be enhanced, and deliveries will be safe to both the baby and mothers.

References

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