After a Cesarean

Thank you to ICAN for making this amazing brochure to help women all across the world. For those who are unable or have not seen the brochure at this point, I took the time to type out most of the information on it.

Make an informed choice about the risks of repeat cesareans Vs. VBAC.

Cesarean sections are major abdominal surgery, and like all surgery, carry the risks of complications. These can include dense adhesion's, excessive scar tissue growth that connects the uterus to surrounding tissues and organs. Adhesion's can increase the risk of longer operation times and injury to adjacent organs. The risk of hysterectomy, or the surgical removal of the uterus, also rises. Undergoing repeated cesareans make it more likely a woman will experience placenta accreta, in which the placenta grows into the middle layer of the uterus, possibly causing hemorrhage and requiring a hysterectomy.

A woman who has repeat cesareans can also be more likely to experience thromboebolisms (blood clots that break lose and block vessels), or experience blood loss. And while uterine rupture (a rare but potentially catastrophic event during pregnancy or childbirth in which the uterine wall splits open) remains a concern after one or more cesareans, the risk of uterine rupture is small, and it decreases further with each additional VBAC.

Lets Look at the numbers....

1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)

1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion's : 21.6% (1 in 5)

2nd VBAC
Chance of Successful VBAC : 87.6% (9 in 10)
Risk of Uterine Rupture : 0.45% (1 in 222)
Risk of Hysterectomy : 0.17% (1 in 588)
Risk of Blood Transfusion : 1.24% (1 in 81)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion's : 32.2% (1 in 3)

3rd VBAC
Chance of Successful VBAC : 90.9% (9 in 10)
Risk of Uterine Rupture : 0.38% (1 in 263)
Risk of Hysterectomy : 0.06% (1 in 1667)
Risk of Blood Transfusion : 0.99% (1 in 101)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in 8)
Risk of Dense Adhesion's : 42.2% (2 in 5)

Note : "Major complications" include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.

Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.

Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveres. Obstetrics & Gynecology 2006; 108: 21-6

All VBAC statistics for this are taken from the Mercer & Gilbert study in which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates.