In Australia, most women who walk into an obstetrician's office wanting to VBAC walk out 15 minutes later with the bloody image of a torn up uterus imprinted in their minds. Chilling tales of hysterectomies and dead babies are often told and women, quite rightly, are left feeling they are too scared to "take the risk".

So let's put this risk into perspective. For any woman having a baby regardless of whether she has had a previous caesarean or not, the risk of the baby dying from Congenital defects, prematurity and low birthweight, SIDS and placenta complications are all greater than the risk of a baby dying from a uterine rupture. All of the above risks are extremely rare but do happen so a woman needs to make a decision on what is the best way to have her baby based on her own individual needs and circumstances.

What women aren't told is one of the greatest risk factors for a uterine rupture is inappropriate management of VBAC labour. Despite the fact that inducing and speeding up labour using oxytocic drugs have been proven to significantly increase the risk of uterine rupture whether you've had a previous caesarean or not, many obstetricians still routinely use these drugs to make the length of a labour more predictable.

Another risk factor is the quality of the surgery from a previous caesarean. Some surgical techniques may offer short term benefits but may increase the risks for future pregnancies.

Many obstetricians have a policy of continuous monitoring and epidurals for VBAC labours and these too can increase the risks of complications. Epidurals can mask abnormal pain which may result from a uterine separation and continuous external monitoring does not necessarily pick up abnormal uterine activity but may result in a woman having a long labour due to being confined to a bed with restricted movement. Recent studies have shown that continuous monitoring does not improve outcomes.

Women are also not told that there are strategies they can use to help optimise their chances of an uncomplicated birth. Learning about optimal foetal positioning and active birth, hiring a doula or a private midwife for labour support, declining unnecessary interventions, learning about non-medical techniques to relieve pain, exercising and eating well can all reduce the likelihood of a complicated birth or a repeat emergency caesarean.

Further information and support.

If you have negative feelings about your baby's caesarean birth, you are not alone and support is available. The Maternity Coalition has produced an INFOSHEET on births after caesareans which you can download for free at http://www.maternitycoalition.org.au/

Childbirth Connection also have a comprehensive booklet (see reference below) on the risks of caesareans and vaginal birth (including vaginal birth after caesarean) which you can down load for free at http://www.childbirthconnection.org/

Australian support organisations include CARES-SA (Caesarean Education Recover and Support, South Australia www.cares-sa.org.au), Birthrites: Healing After Caesarean (WA-based www.birthrites.org) and Birthtalk: Support, Education and Celebration of Birth (Qld http://www.birthtalk.orgA new national organisation Caesarean Awareness Network Australia (CANA) has also been established to help direct women to evidence-based information and resources about caesareans and birth after caesarean.

References

Listening to Mothers Survey II, Childbirth Connection (2006). http://www.childbirthconnection.org/

Childbirth Connection (formerly Maternity Center Association) (2004) What every pregnant woman needs to know about caesarean section. http://www.childbirthconnection.org/">www.childbirthconnection.org.>

WHO 2005 global survey on maternal and perinatal health research group. (2006).

Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet June 3, 2006; vol. 367: 1819-29.