Originally Posted 1/28/2015
If you are having a baby, or have had a baby, it's likely that you've come across the term "VBAC". It's the well known acronym that stands for Vaginal Birth After Cesarean. This carries heavy meaning for many women, but what does it mean specifically to women in the Big Country?
Child bearing women in the Abilene area need to know where our hospitals stand as it relates to women avoiding unnecessary surgeries that may come with life altering risks. I've been trying to work my magic in the Google machine, but recent data and statistics are hard to come by.
Here is the data I've collected:
One of the biggest influences on VBAC is the primary cesarean rate. If we can avoid an unnecessary primary (first) cesarean, then we can avoid the need for a VBAC in future pregnancies.
According to the 2010 Primary Cesarean Rates in Texas, the primary cesarean rate is 17.69% at Abilene Regional Medical Center. According to the same source, Hendrick Medical Center had a primary cesarean rate of 19.01%. Though far from being the best in the state, the rates are close to the state average of of 19.56%. It is worth noting, however, that the World Health Organization states that cesarean rates for both primary and repeat cesareans combined should fall somewhere between 5-15%, with 20% being considered "overuse".
Obviously, sometimes cesareans are going to be needed. But what is a mom to do after that first cesarean? Contrary to popular belief, once a cesarean does NOT always mean a cesarean. If a care provider is truly VBAC supportive, their VBAC success rate should be somewhere around 75%. This means that if you take 100 women who have had a previous cesarean, 75 of them should deliver vaginally and 25 will have a repeat cesarean (CBAC).
Where does Abilene stand? According to the data, the 2010 VBAC Success Rates in Abilene are as follows:
Abilene Regional Medical Center: 4.00%
Hendrick Medical Center: 0.92%
This data reflects the percentage of VBACs among ALL births in the hospital in that year, not just attempted VBACs.
Again, let's keep in mind that these figures are four years old, so perhaps they have improved since 2010. I would love to see where they stand now.
Now, let's get to our overall cesarean rates. The most recent data I was able to find came from CesareanRates.com in 2011. At that time, it was found that Abilene Regional Medical Center's cesarean rate was 37.5%. At Hendrick it was 37.2%.
It's hard to say where we should be when the data I'm looking at comes from different years, but if I just use what I've got, this is a relative approximation of the prevalence of VBAC in our area:
At ARMC, if we take the total cesarean rate at 37.50% and subtract 17.69% (the percentage that are primary cesareans) that gives us 19.51% repeat cesarean. Let's round it to 20% to make the math easier and add in the 4% of reported successful VBACS; this gives us a 24% baseline for the total number of women who could potentially be considered for VBAC. If only 4 out of 24 are having a successful VBAC, that means that 83% of the women from this pool had either a repeat cesarean or an unsuccessful VBAC.
Now let's look at Hendrick. If the overall cesarean rate is at 37.20% and we take away the primary 19.01 percent of primary cesareans, that gives us 18.19% potential VBAC'ers. Let's use 18% for easier math and add in the 1% VBACs that occured in 2010. This means the total pool of repeat cesareans and VBACs make up 19% of the births. If we isolate that 19%, and we know that only 1% of the whole are having succesful VBACs, that means that 99.95% of the women who have had a prior cesarean are having another cesarean.
It is not possible to see the actual VBAC success rate because we don't have a figure for the percentage of women who actually attempted to have a VBAC. The VBAC success rate could be good. But the fact that such a large percentage of the women are having repeat cesareans should show us that not ENOUGH women are attempting a VBAC.
Why aren't they? That's another blog for another day, I guess.
In 2012, the NATIONAL cesarean rate stood at 32.8%. Do you see what this means? Just a year earlier, our hospitals were already well over the national average and our VBAC rates fell miserably below the mark. This does not necessarily mean that we don't have good hospitals or providers, but it IS an indication that our birth community needs some work.
Birthing mothers in our community should know ACOG's recommendation about VBAC: "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists."
I strongly recommend birth classes to ALL women, but especially moms who are seeking to have a VBAC. It takes a lot of commitment on behalf of the physicians who are willing to take VBAC patients. Mothers need to have the same level of commitment so that we can create a healthier, safer birth community here in the Big Country.
For more information about VBAC, check out VBACFacts.com.
Here's what providers are saying about Birth Boot Camp and how we help moms have successful VBACs:
If you are interested in learning more about preparing for a successful VBAC, feel free to email me at CountryBumpkinDoula@Gmail.com. You can also message me on Facebook.