I received a request for info on the risks of VBAC after 2 or more cesareans versus planned repeat cesarean with 2 or more cesareans and thought it might be interesting to crowdsource it and see how the 16,000 Facebook fans would respond.
Here were the links provided. What do you think of this snapshot of resource sharing in terms of information shared, sources and the community itself, if anything?
Not linked but there were referrals to ICAN (http://www.ican-online.org)
And the notes from physicians who chimed in…
Physician #1: Would refer to the ACOG Practice Bulletin from August 2010 which addresses rates of uterine rupture after two previous CDs. Consensus is that reasonable to offer TOL to most women. Limited data on more than two CDs.
Physician #2: Honestly, that is a question without an realistic answer. The risks of both options are many and varied. The risk factors for both options are also many and varied. And finally the interplay of those risk factors is so complex as to make predictions of any one individual’s risk of any given event, based on data virtually useless. I am currently practicing in an environment where the risk of uterine rupture is HIGHER in a primip than it is in a VBA2C or even a VBA3C. That has a lot to do with age at first pregnancy, nutritional and developmental history, and current nutritional status. If you narrow the question, say to a given geographic area and a given ethnic heritage, a range of body mass indices, a range of diets, a range of prenatal care and delivery options (type and experience of attendant, place, experience, and protocols of the intended facility. you could generate some sort of rational comparison. But just to compare the generic “risk” of a given procedure with another given procedure is without value. Yes you can obtain a number, which makes you think you know something that you don’t really know. But that number has virtually no predictive validity for a specific individual.
(continued) Actually I misspoke, the number of ruptures is much higher in our primips than in our VBACs - regardless of number of sections, probably on the order of a hundred to one or more, but I haven’t collected or analyzed the relative rupture rate.