September’s Birth journal has an excellent roundtable discussion on VBAC and its safety relative to repeat cesarean. Two stories are presented – both women who had previous cesareans, one for “failure to progress” following an induction, and the other for cephalo-pelvic disproportion (CPD). In their subsequent pregnancies one has a repeat cesarean following the advice of her caregivers and family, the other a successful VBAC after finding an obstetrician who believes that “no one can know in advance what will happen during a birth”. Following their stories is a discussion from a family practice doctor, an obstetrician, a midwife and a doula.

This article highlights many of the myths that surround VBAC and the importance of the beliefs of the caregiver in determining whether or not a VBAC will be even attempted, let alone successful. One of the authors refers to the Landon et al study (2004) which provides us with the best information on the safety of VBAC versus a repeat cesarean. This study contradicts the commonly held belief that cesarean is safer than VBAC for either mothers or their baby’s.

The family physician offers a number of reasons to explain the increasing cesarean rate which is a global phenomenon including a feto-centric perspective held by many caregivers where they feel they are responsible for being the advocate of the unborn child, despite the increased risks to the mother of a surgical birth. At the end of his discussion the physician confesses to having previously told one of the women in the story that a VBAC was unlikely to be successful and has since recognised that as a careprovider caution should be exercised when giving advice because of the huge impact a doctor’s words can have on a woman.

Overall this is an excellent article – one that is worth including in the information available to the parents you work with who may be considering VBAC but have had family or caregivers voice concerns over its safety.

The article is called: Roundtable Discussion: “No One Can Condemn You to a C-Section!”

Authors: Feldman, P., Cymbalist, R.,  Vedam, S., & Kotaska A

Birth, vol. 37, iss. 3, pp. 245-251

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