Episode 61: Rollin’ it back: History of Vaginal birth After Cesarean

In this episode, we explore a decision faced by many pregnant people: choosing between having another C-section or attempting a VBAC (Vaginal Birth After Cesarean). Many opt for another C-section because its more commonly discussed and well-known, but the VBAC offers several benefits like quicker recovery and lower infection risk. The concept of VBAC emerged in the 1920s, and gained more popularity over time. But its history is more than meets the eye! Join us in this episode as we dive more into the fascinating and complex history of the VBAC!

Listen to the episode, discuss these questions with friends and family, let us know what you think!

Show Notes:

Women who have had previous C-sections face a choice between another C-section or attempting a VBAC (Vaginal Birth After Cesarean).
VBAC poses a risk of uterine rupture at the scar site, similar to a weak spot on a patched bouncy ball that is more susceptible to tearing.
Over 80% of women opt for repeat C-sections, as reported by CDC data.
Benefits of choosing VBAC include avoiding abdominal surgery, experiencing a quicker recovery, reducing the risk of infection, and minimizing blood loss.
Ideal candidates for VBAC typically include those with a prior horizontal uterine incision, a history of successful vaginal births, or a previous C-section for non-recurring reasons (e.g., breech presentation).
Success rates for Trial of Labor After Cesarean (TOLAC) attempts range from 60% to 80%.
C-sections have historical roots dating back to the 1500s, with significant safety improvements occurring in the early 1900s, while VBAC trials gained traction in the 1920s.
Advocacy for VBAC increased in the 1980s and 1990s amidst rising C-section rates, yet complications like uterine rupture contributed to VBAC rates dropping to less than 1% by 2006.
The initial inclusion of race and ethnicity in the VBAC calculator led to underestimations of VBAC success for Black and Hispanic women, highlighting systemic racism in obstetrics.
A revised calculator in 2021 removed race and ethnicity, aiming for a fairer assessment, and incorporated additional factors such as chronic hypertension treatment.
The Healthy People 2020 goal aimed to increase VBAC rates to 18.3%; however, actual rates saw only modest growth from 12.4% to 13.3% between 2016 and 2018.
Understanding VBAC as a viable option after a prior C-section is crucial, requiring informed discussions with healthcare providers and utilizing updated calculators for decision-making.

Sources:

American College of Obstetricians and Gynecologists. (n.d.). Vaginal birth after cesarean delivery. Retrieved June 17, 2024, from https://www.acog.org/womens-health/faqs/vaginal-birth-after-cesarean-delivery

Cragin, E. (1916). Conservatism in obstetrics. The New York Medical Journal, 103(26), 1261-1264. Retrieved from https://history-of-obgyn.com/uploads/3/5/4/8/35483599/1916-cragin-conservatism-rev-dec2014.pdf

Faulkner, S. L., Black, R., Patil, C. L., et al. (2022). Why equitable access to vaginal birth requires the abolition of race-based medicine. AMA Journal of Ethics, 24(3), E270-E276. https://doi.org/10.1001/amajethics.2022.270

Frederick, J., Fletcher, H., Szychowski, J. M., et al. (2013). Racial differences in the success rate of trial of labor after cesarean: A systematic review. Obstetrics & Gynecology, 122(4), 800-808. https://doi.org/10.1097/AOG.0b013e3182a1014c

History of OBGYN. (1927). Post-cesarean pregnancies: 130 cases. American Journal of Obstetrics and Gynecology, 13(4), 597-600. Retrieved from https://history-of-obgyn.com/uploads/3/5/4/8/35483599/1927-rice-130pregnanciespostcs-rev-mar2016.pdf

Wagner, M., Zelaya, C. E., & editors. (2005). Technical updates on the birth after cesarean issue. Washington, DC: World Health Organization; 12-15

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