Factors associated with successful vaginal birth after Caesarean

Melissa Lunsford wants a vaginal delivery for her fourth child. Following a series of Caesarean and vaginal deliveries for her other children, she couldn't find a doctor or a hospital willing to give her the vaginal birth option for her current pregnancy.

Unfortunately, too many women like Lunsford face the same challenge, says an advocate of vaginal births after Caesarean (VBAC) from Ben Taub General Hospital, one of the top VBAC-delivery hospitals in Texas.

"For some clinicians and hospitals, the prospect of offering a trial of labor after a Caesarean delivery is too risky. While risks exist, the possibility of delivering vaginally is still a viable option for many women," says Dr. Christina Marie Davidson, chief, Obstetrics and Gynecology Services, Ben Taub General Hospital, and assistant professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine.

Finding a physician and hospital that offers VBAC procedures can be difficult. Most doctors or hospitals don't have access to 24/7 hospital coverage by physician services in obstetrics, gynecology, anesthesia, neonatology with a neonatal intensive care unit, operating room availability for emergent Caesarean deliveries, massive blood banking and expert nursing. At the Harris County Hospital District, the health system that operates Ben Taub General Hospital and Lyndon B. Johnson General Hospital, the Women and Infant Services has all medical coverage needed to make VBACs a viable option for women even after more than one Caesarean delivery.

In fact, Ben Taub and LBJ hospitals share the state's highest VBAC rates of all hospitals, respectively 27.86 percent and 29.58 percent, according to a 2009 report by the Texas State Department of Health Services. Tthe rates of Ben Taub and LBJ hospitals are routinely three times higher than the national VBAC rate of 8 percent.

"We believe women should have that choice. We can't guarantee that they'll have a VBAC delivery every time, but we can certainly plan for it," Davidson says.

Factors associated with an increased likelihood for a successful VBAC include:
• Not facing a similar condition for the previous Caesarean
• Successful vaginal delivery or VBAC in past
• Previous Caesarean not for cervix complications or infant not descending through birth canal
• Labor starts on its own
• Younger than 35 years of age

After being repeatedly told of the inherent risks and dangers, Lunsford sought answers and comfort on the Internet. Her research of successful testimonials gave her hope. She next began an arduous search for a VBAC-friendly doctor.

"Everyone I talked to, including my friends, basically told me it was silly to think of delivering vaginally again after a Caesarean. But, it is important to me and something I knew I wanted," she says.

After contacting 10 doctors to deliver her baby, Lunsford finally found Davidson, who not only had the expertise, but who's also an impassioned supporter of VBACs.

"Women who choose to have a vaginal birth after Caesarean should have that option and not be discouraged because of a lack of knowledge or resources," Davidson adds.

For Lunsford, the chance to deliver her son as naturally as possible is worth the effort.

"It is important to me and important to my entire healthcare team," she says.