AT LAST!!! More research to add to that of Dr Mark Landon.
Planned vaginal birth after caesarean (VBAC) refers to any woman who has experienced a prior caesarean birth who intends to try for a vaginal birth rather than to deliver by elective repeat caesarean. Although relatively low complication rates, including uterine rupture, have been demonstrated among women with two prior low-transverse caesareans who attempt vaginal birth, there are very limited data available on outcomes among women with more than two prior caesareans. Neither the American College of Obstetricians and Gynaecologists (ACOG) nor the Royal College of Obstetricians and Gynaecologists (RCOG) currently recommend planned VBAC attempt in women with three or more prior caesarean deliveries1.
In this study, the researchers sought to estimate the rate of success and risk of maternal morbidity in women with three or more prior caesareans who attempt VBAC. The study reviewed multi-centre data from 17 tertiary and community delivery centres in the Northeastern United States from 1996 to 2000. A total of 25,005 women who had a least one prior caesarean delivery were included.
The findings indicate that women with three or more prior caesarean deliveries did not experience a difference in morbidity based on whether they attempted VBAC or elected for a repeat caesarean. The 89 women with three or more prior caesareans who attempted VBAC were as likely to be successful as women with one or two prior caesareans, 79.8% compared to 75.5% and 74.6% respectively. In addition, none of them experienced significant maternal morbidity such as uterine rupture, uterine artery laceration, and bladder or bowel injury.
The older findings of Dr Mark Landon back in 2006:
Sadly, childbirth can be risky, so can crossing the road. We don't ban someone from crossing the road just because they happened to have an accident once, or twice. Sorry to be flippant! I appreciate that things can go wrong during any birth. They happen to go wrong a bit more often in birth which has interference. I recall hearing from two women within a week or two who had suffered uterine ruptures. Both had been induced, but only one had a previous scar on her uterus!
So, when women want to plan a VBAC, of any kind, it is important to support them fully. They are not selfish, wanting something for themselves, at any cost..... They are human beings who want the best birth possible for themselves and their baby. If they are fully supported during their antenatal and intrapartum periods they have the highest chance of success. If they feel listened to and respected they will then trust their caregivers, will believe that the caregivers will provide quality care with honesty and, if the birth deviates from normal, will be able to listen and make informed decisions quickly during labour. If a repeat section or assisted delivery is required then the mother will not feel violated, let down, coerced, traumatised.... she may well feel disappointment at the outcome not being as she planned for, but she will be happy that she laboured, that she was treated like a normal human being, that the assisted birth or Caesarean was for sound medical reasons and that she gave it her best shot. I also believe that morbidity and mortality will be reduced significantly as a result.
She will probably still be angry about the first Caesarean if she felt violated, let down, coerced, traumatised during that birth. She needs to be listened to, and her feelings respected. Too many women get told "you should be grateful" No, they shouldn't!!!! Their feelings are valid and how dare anyone think that a woman would put her baby second to herself! But a mother is not much use to her baby, or anyone, when she's suffering from Postnatal Depression or, more likely, Post Traumatic Stress Disorder. Childbirth is more than just a physical process, it is also hormonal and pyschological.
If we support a woman to have the best birth for her then she can feel good about a necessary Caesarean, but if we do not provide care and respect then even a physiological birth which sounds great on paper could leave a woman feeling traumatised.
I believe childbirth is very much a mental health issue.