Vaginal Birth After Caesarean Section
Upstate New York Birth Injury Malpractice Attorneys
Legal Help for Families Who Suffered Infant Injury or Death Through Failure to Perform a C-Section
The personal injury attorneys at Powers & Santola, LLP, do not endorse one form of delivery over another. The decision whether to have a vaginal delivery or a caesarian section, after a mother has had a prior caesarian section, is a decision that should be made by the mother and her doctor, after due consideration of the medical risks.
As medical malpractice attorneys, we see many clients who have suffered serious consequences as a result of vaginal birth after c-section (VBAC). We feel it is important to present a different view of the relevant medical studies so parents can understand the real risks of VBAC before they attempt a vaginal birth.
Between 1970 and 1995, the c-section rate increased from 5 percent to 24.7 percent. Because of a concern that the uterus could tear apart at the site of a previous c-section incision, mothers who had prior c-sections were advised against later vaginal deliveries.
Believing that the rate of c-sections was too high, the American College of Obstetricians and Gynecologists began to encourage a "trial of labor," allowing an expectant mother to choose whether she would try to deliver her baby vaginally. When discussing this option, doctors often told expectant mothers that:
- Most medical studies reported that 60 to 80 percent of all "trials of labor" after a c-section resulted in a successful vaginal birth.
- VBAC avoided the risks associated with surgery (infection, anesthesia risk, blood transfusions, longer hospital stays).
- If the mother's condition was carefully monitored, a uterine tear or rupture could be promptly identified and the child could be delivered by c-section.
In theory, the risks associated with a VBAC were not much greater than the risks associated with a c-section. However, something very important was lacking from this conversation — consideration of how hospitals actually operate.
Most hospitals do not have an operating room or medical staff on stand-by. It takes up to 30 minutes from the time a doctor orders an emergency c-section until the surgery actually starts. This delay can be critical.
When a uterus begins to rupture, the baby's oxygen supply is immediately reduced or completely cut off. Even a 15-minute delay in performing an emergency c-section can result in permanent brain injury or death. Uterine rupture is also dangerous for the mother, who may suffer massive blood loss. She may also lose her uterus.
What Are The Risks Of VBAC?
A 60-80 percent "success rate" for VBAC means that 20-40 percent of expectant mothers attempting a "trial of labor" fail. There is a distinct increase in risk to the baby in those cases where VBAC fails. Recent studies have determined that the risk of uterine rupture is three times greater, and the rate of fetal death is eleven times greater, for a VBAC than for a planned repeat c-section.
In simple terms, the increased risks associated with a c-section are all risks to the expectant mother's health, while the increased risks associated with a failed "trial of labor" are risks to the baby. These risks may be catastrophic if they occur.
What it Means to Give Informed Consent
For an expectant mother to give meaningful and informed consent to a "trial of labor," she must be specifically told that if her uterus ruptures during VBAC, there may not be sufficient time to operate to prevent injury to herself or to her baby. Only when this warning is clearly stated, and all other risks and benefits are explained and understood by the expectant mother, can she give truly informed consent to attempt a vaginal delivery.
Can You Choose to End a Trial of Labor?
YES, at any stage of labor, an expectant mother has the absolute right to choose an immediate c-section. The expectant mother must be able to have continuous, honest dialogue with her medical care providers, especially if any changes occur during the labor that might increase the risk of continuing a vaginal delivery. Ongoing reassessment is essential to making an intelligent decision about delivery.
If you were injured or suffered the loss of a child because you were not informed of the risks of VBAC, talk to an attorney who understands. Contact Powers & Santola, LLP, in upstate New York. Our lawyers offer sound legal advice and honest answers in a free consultation.
