The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

VBAC Success - Story and Rates

VBAC Mom Tells Her Story

Anyway, I think one thing that helped me was knowing that I was doing everything I could possibly do to encourage VBAC success. I did everything I could think of and everything that was suggested to me. I used a midwife practice, I read everything I could find on VBACs, I took a Bradley class, I wrote a really detailed birth plan, I arranged for a labor assistant to be present at the birth, I drank Red Raspberry Leaf tea and then took capsules too, I took Evening Primrose Oil orally starting at about 37 weeks and then masaged in onto my cervix daily from 38 1/2 weeks, I packed a labor bag w/ everything one could possibly ever need, etc.

I also faced the fact that w/ my last birth, I really had had the attitude that I didn't need to do anything to birth my baby. I had walked into the hospital without a birthplan expecting for those good people to remove my baby for me...and that's exactly what they did. This time I realized that I was the one who was responsible and I had to do it on my own...and that's pretty much what I did!

I wish you all the wonderful success that I had.

Abstracts on VBAC Success Rate

Author: Walton-D-L. Ludlow-D. Willis-D-C.
Title: Vaginal birth after cesarean section. Acceptance and outcome at a rural hospital.
Source: J-Reprod-Med. 1993 Sep. 38(9). P 716-8.
Journal Title: JOURNAL OF REPRODUCTIVE MEDICINE.

Abstract: A retrospective review of all pregnant women with a history of cesarean section was conducted at an isolated military hospital. During the two-year period 1988-1989, 62 patients were initially considered eligible for attempting vaginal birth after cesarean section (VBAC). Seventy-nine percent (49/62) of the patients initially requested a trial of labor, and 14 of them ultimately did not meet American College of Obstetricians and Gynecologists criteria. Three patients reversed their decision late in pregnancy. Eighty-eight percent (28/32) of those undergoing a trial of labor delivered vaginally. The three patients with more than one prior cesarean section all delivered vaginally. The four failures occurred in patients who had a history of well-documented cephalopelvic disproportion. Perinatal morbidity consisted of intrauterine fetal demise prior to the onset of labor at 40 weeks' gestation. Maternal morbidity included postcesarean endometritis (n = 1) and vaginal sidewall laceration (n = 1). These results indicate that in a rural hospital VBAC was well accepted by patients and was safe; however, further study is required.

Author: Brody-C-Z. Kosasa-T-S. Nakayama-R-T. Hale-R-W.
Title: Vaginal birth after cesarean section in Hawaii. Experience at Kapiolani Medical Center for Women and Children.
Source: Hawaii-Med-J. 1993 Feb. 52(2). P 38-42.
Journal Title: HAWAII MEDICAL JOURNAL.

Abstract: Medical records at Kapiolani Medical Center for Women and Children were reviewed for cases that had a trial of labor subsequent to prior cesarean section during the period January 1990 to July 1991. All cases were > or = delivered 36 weeks' gestation. During the 19-month period, 356/483 or 73.5% cases with a trial of labor had successful vaginal births after previous cesarean sections (VBAC). The majority of the others that did not were due to failure of progression in labor. The incidence of scar separation was 5/483 (1.04%). There were 5/483 neonates with Apgar scores of < or = 6 at 5 minutes, giving a perinatal morbidity rate of 1.04%. There were no maternal deaths. Oxytocin induction resulted in successful VBAC in 30/47 (63.8%) cases. This study concludes that a trial of labor for vaginal birth after cesarean section is well established at our institution. In addition, the rates of successful VBAC, its complications and outcomes, are comparable to national averages.

Author: Abitbol-M-M. Castillo-I. Taylor-U-B. Rochelson-B-L. Shmoys- S. Monheit-A-G.
Title: Vaginal birth after cesarean section: the patient's point of view.
Source: Am-Fam-Physician. 1993 Jan. 47(1). P 129-34.
Journal Title: AMERICAN FAMILY PHYSICIAN.

Abstract: Advocacy of vaginal birth after cesarean section (VBAC) is the current standard of care. We interviewed patients in our program about their attitudes toward VBAC and cesarean section. The success rate in our VBAC program is similar to rates reported in the literature (65 percent). However, interviews with our patients revealed that 40 percent had no desire to participate in the VBAC program, although they fulfilled the criteria for eligibility. The main reasons given for declining a trial of VBAC were the convenience of an elective cesarean section and fear of another prolonged, painful and potentially dangerous labor. Thirty-two percent of patients in whom VBAC was successful were dissatisfied with the experience and would have preferred an elective cesarean section. The reasons patients gave for attempting VBAC were different from the medical reasons proposed to them. The main reasons given were a desire to deliver "naturally," a fear of surgery and the concern that cesarean section might harm them or their baby.

Author: Learman-L-A. Evertson-L-R. Shiboski-S.
Title: Predictors of repeat cesarean delivery after trial of labor: do any exist?
Source: J-Am-Coll-Surg. 1996 Mar. 182(3). P 257-62.
Journal Title: JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS.

Abstract: BACKGROUND: We evaluated the predictive value of risk factors for repeat cesarean delivery identified in retrospective studies. STUDY DESIGN: We identified 175 consecutive patients who underwent trial of labor (TOL) and compared detailed admission, intrapartum, and postpartum characteristics of those who required repeat cesarean delivery with those who had vaginal births. We calculated relative risks, positive predictive values, and sensitivities for potentially predictive admission characteristics. We also performed multiple logistic regression and classification analyses. RESULTS: Ninety-five percent of eligible patients underwent a TOL, and 85 percent of them delivered vaginally. Patients who had labor induced and patients with high fetal station on admission were significantly more likely to require repeat cesarean section (relative risk [RR]=2.9 and 2.1; 95 percent confidence interval [CI]=1.5 to 5.3, 1.1 to 4.2, respectively), but even these patients had high rates of vaginal birth (67 percent and 75 percent, respectively). A subgroup of patients who underwent labor induction and had large fetuses (estimated weight 3,800 g or more) had a 75 percent risk of cesarean delivery (RR=2.5, 95 percent CI=0.9 to 7.5). Multivariate models using different combinations of admission characteristics could not correctly identify which patients would require repeat cesarean delivery. CONCLUSIONS: Admission characteristics with statistically significant risk ratios have low predictive values because of the extremely low rate of repeat cesarean delivery in this population. A larger series is needed to study TOL outcomes in patients with large fetuses who are being induced. We conclude that until risk factors with high predictive value for repeat cesarean delivery are identified, all eligible patients should be encouraged to undergo a TOL.

This next one is not from the U.S., but from the Middle East.

Author: Abu-Heija-A-T.
Title: Vaginal birth after one previous caesarean section: a Jordanian experience.
Source: J-Obstet-Gynaecol. 1995 Feb. 21(1). P 9-12.
Journal Title: JOURNAL OF OBSTETRICS AND GYNAECOLOGY.

Abstract: In this prospective study, 119 women out of 135 (88%) of cases delivered previously by one lower segment caesarean section at Princess Basma Teaching Hospital in North Jordan, had a trial of labour, 103 out of 119 women (86.6%) delivered vaginally. A high incidence of vaginal delivery occurred in women originally delivered by caesarean section for cephalopelvic disproportion (CPD) (69%). Repeat caesarean section was necessary only in 13.4% of women mainly because of CPD and foetal distress. Labour was induced for obstetric reason only. The incidence of scar rupture was very low 1 of 119 cases (0.8%), with no maternal deaths. The duration of labour doesn't differ significantly for those who had from those who never had vaginal delivery before. So it is relatively safe to have a trial of labour in patients delivered previously by one caesarean section.

Author: Weinstein-D. Benshushan-A. Tanos-V. Zilberstein-R. Rojansky- N.
Title: Predictive score for vaginal birth after cesarean section.
Source: Am-J-Obstet-Gynecol. 1996 Jan. 174(1 Pt 1). P 192-8.
Journal Title: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY.

Abstract: OBJECTIVE: Our purpose was to evaluate the relative weight of the different variables that may influence the chances of vaginal birth after one cesarean delivery, with the aim of developing a predictive score for success of such a trial. STUDY DESIGN: In this retrospective study, which covered a 10- year period (1981 to 1990), 471 women who attempted vaginal birth at a level III university hospital after one abdominal delivery were studied as to the subsequent delivery outcome. An attempt to identify possible prognostic factors for success of such a trial was made. RESULTS: A trial of labor was successful in 368 (78.1%) of women and 103 (21.9%) had a repeat cesarean section. Variables of significant predictive value were vaginal birth before cesarean section (odds ratio 1.8), malpresentation (odds ratio 1.9), pregnancy-induced hypertension (odds ratio 2.3), and Bishop score > or = 4 (odds ratio 6.0). Cephalopelvic disproportion and failure to progress did not demonstrate a significant predictive value (odds ratio 0.81) for success or failure in subsequent delivery. In fact, 63.8% of women with this indication have successfully undergone vaginal delivery. Maternal age (odds ratio 0.9) had no bearing on vaginal delivery success rates, whereas both macrosomia (odds ratio 0.2) and intrauterine growth retardation tended to decrease the chances for vaginal birth after cesarean section. CONCLUSIONS: A trial of labor after one cesarean section should be encouraged in most women who are willing to attempt it, provided no obstetric contraindication exists. A scoring system that may help to identify women with a greater chance for vaginal delivery is proposed.

Author: Segal-S. Gemer-O. Zohav-E. Siani-M. Sassoon-E.
Title: Evaluation of breast stimulation for induction of labor in women with a prior cesarean section and in grandmultiparas.
Source: Acta-Obstet-Gynecol-Scand. 1995 Jan. 74(1). P 40-1.
Journal Title: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA.

Abstract: BACKGROUND. Information on the efficacy of breast stimulation for inducing labor in grandmultiparas and in women with a previous cesarean section with or without premature rupture of membranes is limited. METHODS. Retrospective study of labor data from 135 women of grand multiparity or those with a previous section with or without premature rupture of the membranes in whom labor was induced by breast stimulation. RESULTS. The success rate in achieving vaginal delivery was 84%. The duration of breast stimulation, length of labor, vaginal delivery rate, and Apgar score did not differ significantly among the four groups studied. CONCLUSION. Breast stimulation in grandmultiparas and in women with a previous cesarean section is efficacious and safe.

Author: Chattopadhyay-S-K. Sherbeeni-M-M. Anokute-C-C.
Title: Planned vaginal delivery after two previous caesarean sections [see comments]
Source: Br-J-Obstet-Gynaecol. 1994 Jun. 101(6). P 498-500.
Comment: Comment in: Br-J-Obstet-Gynaecol. 1995 Mar. 102(3). P 262-3.
Journal Title: BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY.

Abstract: OBJECTIVE: To determine the outcome of trial of labour after two caesarean sections. DESIGN: Prospective observational study. SETTING: Maternity and Children's Hospital, Riyadh, Saudi Arabia. SUBJECTS: Women with two previous caesarean sections considered suitable for a trial of vaginal delivery. MAIN OUTCOME MEASURES: The rates of vaginal delivery, scar dehiscence, uterine rupture and associated complications among 115 women with two previous sections who underwent trial of labour were compared with 1006 women with two previous sections who did not have a trial of labour. RESULTS: Trial of vaginal delivery was requested by 230 out of 1136 women (20%) who had two previous caesarean sections. Of the 115 women accepted for the trial, 103 (89%) were delivered vaginally. Labour started spontaneously in 78 (68%) of the 115 women and was induced with prostaglandin (PGE2) in the remaining 37. Augmentation of labour with oxytocin was required in 32 (28%) of the trial labour group. There were no scar dehiscences among the women delivered vaginally. There was one scar dehiscence and one woman required hysterectomy after failed trial of labour, a frequency comparable to the occurrence of these complications in women who did not have a trial of labour. CONCLUSION: A trial of labour in selected patients with two previous caesarean sections appears a reasonable option.

Author: Zheng-C-W. Hong-W. Lin-F-G.
Title: [Trial vaginal delivery for women with previous cesarean section]
Source: Chung-Hua-Fu-Chan-Ko-Tsa-Chih. 1994 Aug. 29(8). P 456-7, 508.
Journal Title: CHUNG-HUA FU CHAN KO TSA CHIH [CHINESE JOURNAL OF OBSTETRICS AND GYNECOLOGY].

Abstract: A retrospective analysis was made on 85 cases of trial labor after previous cesarean section (CS) and compared with 100 primiparous vaginal deliveries (as control) during the last 10 years. Oxytocin infusion has been used in 61 trial cases to induce and/or to accelerate labor, and valium, procaine and atropine administered during the labor process in 23 of them. 65 of the 85 cases (76.5%) successfully delivered through the vagina (VD group), while 20 cases (23.5%) had repeat CS following failure in trial labor (CS group), and 3 women had reatened uterine rupture. There was 1 neonatal death in the VD trial labor group. No obvious difference in the Apgar scores of newborns was found between the CS group and the controls, and the duration of the labor process was much shorter in the VD trial group than that in the primiparae (7.51 +/- 2.44 hrs vs. 9.10 +/- 3.75 hrs) (P < 0.01). This study indicated that following a previous uneventful transverse lower segment cesarean section, trial labor should be encouraged under supervision.

Author: Yasumizu-T. Nozawa-A. Kinoshita-T. Kato-J.
Title: Trial of vaginal birth following cesarean section for arrest disorders of labor: analysis of patients with well-documented medical records.
Source: Asia-Oceania-J-Obstet-Gynaecol. 1994 Dec. 20(4). P 407-13.
Journal Title: ASIA-OCEANIA JOURNAL OF OBSTETRICS AND GYNAECOLOGY.

Abstract: We elucidated several controversial problems surrounding the vaginal trial in patients with prior abdominal delivery under the diagnosis of failure to progress or cephalopelvic disproportion, by conducting a prospective 6-year survey on the basis of patients who underwent prior operation for arrest disorders of labor (ADL). Of 45 full-term women who were defined as patients of prior ADL following a review of their past medical records, 28 patients underwent trial of labor and 75% (21/28) were successfully delivered of their infants vaginally. The seemingly critical determinants as to whether or not a vaginal birth is successful are the difference in neonatal weights between prior and current pregnancies as well as the difference between maternal obstetric conjugate and fetal biparietal diameter. These data suggest that patients who underwent prior cesarean section for indications of ADL have a high chance of safely succeeding if given a trial of labor under certain exclusionary criteria.

Author: Turnquest-M-A. James-T. Marcell-C. Spinnato-J-A.
Title: Vaginal birth after cesarean section in a university setting.
Source: J-Ky-Med-Assoc. 1994 Jun. 92(6). P 216-21.
Journal Title: JOURNAL OF THE KENTUCKY MEDICAL ASSOCIATION.

Abstract: Despite numerous reports in the literature almost universally endorsing the safety of a trial of labor after a prior cesarean section, it is used in only a small fraction of eligible patients. Our investigation, conducted at the University of Louisville, examines the safety of such a protocol. Two thousand seven hundred fifty-seven patients were delivered during one year; 282 had a history of at least one prior cesarean section. Of the 259 patients eligible, 218 (84%) underwent a trial of labor, and 168/218 (77%) were delivered vaginally. There were 6 cases of uterine dehiscence and 1 uterine rupture. No hysterectomies were performed. Maternal morbidity was significantly greater in the failed trial-of- labor group. There was one perinatal death that was unrelated to a trial of labor. A previous diagnosis of cephalopelvic disproportion or failure to progress did not preclude a trial of labor, and 69% of these patients delivered vaginally. Our data suggest that a trial of labor following one or more previous cesarean sections is a safe option in a carefully selected population.