The Truth About VBAC Numbers

The Truth About VBAC Numbers

In THIS ARTICLE it is stated that “Statistically speaking you are more likely to have a CBAC (Caesarean Birth After Caesarean) or RCS (Repeat Caesarean) than a VBAC (Vaginal Birth After Caesarean).” However some people have chosen to disagree with that statement. It’s a difficult thing to argue with a VBAC rate of 8% in the US. So why are they arguing about it and why do they present the figure of 75% success? Furthermore why would they choose to argue with an article written for women who didn’t get the birth they wanted, to play semantics with words and numbers?

For the purpose of this article we will look at the numbers on this well renowned website where women access compilations of studies and interpretations of the figures therein. Keep in mind that the figures discussed are mostly relevant to the US but the picture they paint is very arguably comparable to what happens in other places around the world.

So what causes the discrepancy between 8% and 75%? The truth is that when a woman can access a care provider who will attend a VBAC and a venue that will allow it, when her health and her baby’s health are good, and when she fits all the criteria to attempt VBAC with her chosen care provider and venue, then a woman has a 75% chance of success. What this figure fails to acknowledge is that 57% of women in the US are unable to FIND a care provider or venue for their VBAC. Moreover, as pregnancies progress many women who thought they had found a good provider and venue are risked out of VBAC for reasons that do not scientifically contraindicate VBAC.

Overall, in the US, 8% of women who have a caesarean go on to have a vaginal birth, regardless of why they have further surgical births, only 8% VBAC. When we translate that 8% into the 75% of women who got all their VBAC ducks in a row, we see that 10.6% of women with a previous caesarean, attempt a VBAC. 75% of them succeed, not 75% of the 100% of women who had previous caesareans. (the actual number is 10.6666666667%)

When we use the 75% VBAC rate we deny the reality of 92% of women who give birth in an operating theatre more than once. It’s often argued that women are choosing repeat caesareans, and of course this is true, however women aren’t cutting themselves open, doctors are. Why are doctors giving women surgery that they don’t need when we know that caesareans are riskier for women and babies?

In his article Technology in Birth – First Do No Harm Marsden Wagner (who served as Director of Women’s and Children’s Health for the World Health Organization for 15yrs) asserts that 

”While some women might be willing to take risks with their own body, it would be very hard to find a woman willing to take risks with the life or health of her baby just for her own convenience or to avoid labor pain.”

His view is that very few women would choose a caesarean if they were fully informed about the risks. The article shows that although society readily believes that surgeons are performing caesareans because women are requesting them, if they were actually providing services as per request, 57% of VBAC hopefuls wouldn’t be left high and dry without a care provider.

According to our source for statistics above, only 45% of women want to try a VBAC. If surgeons were advising women properly, and giving them what they are legally required to give – informed consent – then more than 45% of women would give VBAC a chance, and less than 57% would struggle to find providers. Thus, without clarification, the 8% figure is a better representation of VBAC success. Citing 75% without explaining what that figure comprises is lying by omission.

Claiming that 75% of VBACs are successful is a free ride for the hospitals and doctors who refuse to entertain true choices in birth and fail to respect a woman’s right to informed decision making. People have said that using the 8% VBAC rate gives all surgeons a bad name, but those surgeons are entitled to defend themselves and furthermore they have lobby groups such as ACOG to do that for them. Admittedly ACOG seem more interested in defending the high caesarean rates – more to the detriment of the women who form their clientele – but that is a problem for surgeons to address, not individual women.

Women seeking VBAC have precious few allies, women forced into RCS or cheated into CBAC have no voice when we defend surgeons as a whole, citing the 75% rate. Yes, some providers are wonderful, but they need to speak openly about the oppressive practices of their colleagues if they don’t want to be tarnished by the overall 8% VBAC success rate.

”The only thing necessary for the triumph of evil is for good men to do nothing.”

Edmund Burke

Another glaringly obvious problem with the 75%  is that the overall caesarean rate is 32.8%. When the VBAC rate is given as 75% it appears that more women give birth vaginally AFTER caesareans than they do before. Who would support that claim? It’s patently absurd to deny such an enormous number of women from participating in the statistics of VBAC. 92% of women, regardless of WHY they have repeat caesareans, should not be excluded from the figures.

Whilst we continue to argue about the true rate of VBAC success we ignore the voices of millions of women who would desperately love a chance at birth. This is especially true when we raise the discussion in response to an article addressing women who are grieving over stolen chances, lack of opportunities, lies, or bullying, and true medical concerns which resulted in a caesarean birth. It’s important for women to know where there are studies and statistics that might aid their decision making process, but what’s more important is to remember that women are not numbers, they are human beings, and so are their babies.

There is a time and a place to talk numbers, and the 75% figure does deserve air time, but only when it is placed in context with all the other factors that have created, an 8% VBAC rate in the US. The statement

“Statistically speaking you are more likely to have a CBAC or RCS than a VBAC” is true. To disagree with that is to play hard and fast with the numbers.

If we say:

“If you can find a care provider and a venue for birth that is genuinely supportive of VBAC. If your health and your baby’s health are optimal, and you continue to fit the criteria for VBAC at your chosen venue with your provider, then you have a 75% chance of success”

Then we are telling the truth.

Conversely we are lying if we say that 75% of women VBAC and then fail to explain that we have omitted the birthing journeys of 92% of women who have more than one caesarean in the US. 

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