Based on 2013 CDC data, the overall country-wide cesarean rate average is 32.2%. (Remember from last week's Truth Tuesday's post- community birth cesarean rates are just 5%). However the rates of VBAC nationwide are just 11.3% It was once believed that the risks of a vaginal birth after cesarean highly outweighed the risks of a repeat cesarean, with patients being told the risk of uterine rupture the main concern. However, in 2017, and updated again in 2019, The American College of Obstetrics and Gynecology (ACOG) now RECOMMEND a trial of labor after cesarean (TOLAC). In fact, ACOG notes several benefits to VBAC:
In fact, ACOG (2019) also states "Given the overall data, it is reasonable to consider women with two previous low-transverse cesarean deliveries to be candidates for TOLAC and to counsel them based on the combination of other factors that affect their probability of achieving a successful VBAC".
The main concerns reported with VBAC is uterine rupture. The risk of uterine rupture in a person that has not had a cesarean is .007%, or 1 in 14,286 (Zwart, 2009). After one prior cesarean, the risk of uterine rupture increases to .5-.9%, or 1-2 in 2000 (ACOG, 2019). While this is a large increase if you look at the rate as still less than 1 in 1,000, the overall risk is small. In addition, only 6% of uterine ruptures are catastrophic (less than 6 in 100,000), meaning 94% of uterine ruptures still have good outcomes.
With the actual occurrence of uterine rupture remaining low, and the benefits of VBAC truly impacting outcomes, VBACs should be offered. In addition, all low risk persons with one prior cesarean (even two as recommended by ACOG), should be offered birth in a community setting if desired! VBAC rates in a community birth setting are 87% (Cox et. al., 2015). It's also important to remember that in a community birth setting, the midwife is there continuously with the client once in active labor, monitoring (more frequently than a non-VBAC client) and assessing the well-being of both the birthing person (especially for abnormal pain) and the baby!
Washington State ranks number ONE in the country for midwife integration into the healthcare system. Washington has a cesarean rate of 27.6% and overall VBAC rate is 18.4% (CDC, 2013). Could the lower cesarean rate and increased VBAC rate be linked to the amount of midwives practicing in Washington? What do you think? Check out your state's midwifery inclusion ranking and statistics at: https://www.birthplacelab.org/how-does-your-state-rank/
Pregnancy can be hard. Labor and birth can be hard. Postpartum can be hard. Being a parent can be hard.
It’s important to remember you CAN do hard things!
Midwifery care encompasses so many layers to care. But one that is most important is being a safe place for clients to just feel. Processing comes when you have a place that you feel heard and loved.
Know that throughout this journey, you are not alone!
For free printable birth affirmations like the one below, follow this link!
It is a common misconception that home birth is not safe.
Truth- Home birth is safe for all low- risk pregnant persons. In fact, a recent study on the outcomes of community birth found that 89.1% of low risk pregnant persons planning a home birth with a midwife successfully delivered at home, and the overall cesarean rates are just 5.2% compared to a national average of 31%. In addition, those attempting a VBAC had a success rate of 87%! Postpartum maternal transfer rates were only 1.5% and newborn transfers were only 0.9% (Cheyney et. al., 2014)
Midwives are trained to manage normal labor and birth, recognize variations of normal, and manage obstetrical emergencies. During labor, midwives monitor the client’s vitals as well as the baby’s heart rate. In fact, once in active labor, your midwife is present continuously to ensure the safety of both the client and the baby.
In the state of Washington, midwives are able to carry medications to manage hemorrhage, antibiotics, IV fluids, and more! In addition, the entire midwifery team present at the home birth is certified in NRP just in case baby needs some help after birth.
Take a look at just SOME of the gear that Midwife Ashley carries to every birth!
Have questions about the safety of home birth? Feel free to ask here!
To read the study in full: https://onlinelibrary.wiley.com/doi/full/10.1111/jmwh.12172