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Medically Verified By: - Dr Vinoad Bharrati, Obstetrician and Gynaecologist, Director, Elite Momz unit of Rising Medicare Hospital.
Vaginal Birth After Caesarean Section (VBAC): Is It a Safe Option for Mothers?
Vaginal Delivery: According to WHO C-section percentage should not go beyond 10% but in the past few years all over the world, the C-section percentage has increased to near about 20 to 21%. In India in 2015 16 C section percentage was near about 21% and in 2019 20 percent went beyond 30%.In the current scenario, C-section percentage is nearly 30 35%, especially the increasing percentage in private hospitals.
There are many factors which are supposed to be responsible for increasing the C-section percentage in our country which includes increasing literacy, organizational factors, financial incentives, sociocultural factors, health implications, and so on.
TOLAC (Trial of labour after Caesarean) should be given as an option for deliveries after Caesarean. VBAC (Vaginal birth after Caesarean) is a retrospective diagnosis if successful vaginal birth happens after TOLAC. If the trial fails and delivery happens by C-section, it is labelled as CBAC( Caesarean delivery after Caesarean).
Many patients and clinicians do not choose the option of TOLAC due to fear of scar rupture. Definitely, this complication is very dangerous for the life of a pregnant lady and baby, but we should look into the facts of figures that the percentage of success of TOLAC is near about 52 70% while the percentage of scar rupture is in the range of 0.4 -- 1%. Option of vaginal birth after Cesarean can be a safer option for mothers if it is implemented by a set of rules, by expert hands, at a well-equipped Institute.
A detailed history of the patient, Regarding the previous C-section should be recorded in context to the indication of C-section, which was previously done.
The full course of pregnancy is similar to other pregnancies and routine protocols. The only difference between previous C-section patients who are going to opt for TOLAC is a selection of the team and Hospital. After the spontaneous onset of labour and primary assessment, the patient will be under continuous topographic monitoring and vital monitoring for Mother. A partogram tool to monitor labour progress is being used to keep watch on timelines. Fetal bradycardia is the earliest indication of scar rupture and should be looked for during the progress of labour. Epidural analgesia can be offered for pain relief during the labour process. The success rate for TOLAC is around 50 70% with expert hands and a correct selection of patients.
Benefits of TOLAC:
In cases of TOLAC, there are three possible scenarios, which are VBAC, CBAC, and scar rupture. In VBAC Maternal and Fetal risk are very low. In cases of CBAC Maternal and neonatal morbidity are similar to instances of planned elective C-section. The risk involved in scar rupture is very frightening, but the percentage fortunately is very low, 0.3 1%. And that too can be mitigated with export hands and strict monitoring of labour and timely conversion of TOLAC into CBAC.
With a broader perspective, the selection of TOLAC is a safer choice for pregnant ladies in the hands of an expert team. This can change the percentage of C-section nationwide and help to reduce financial burden as well.
In the current scenario, major private hospitals are working with insurance companies and financial compensation given for C-section is higher than normal delivery. The current structure of financial compensation does not involve TOLAC as a mode of delivery. If financial compensation is kept for TOLAC and C-section will be the same, that will motivate many hospital authorities and obstetricians for implementing TOLAC protocol to increase vaginal birth possibilities.