The E-mail to Dad

E-mail I sent to Dad after we had a lengthy discussion:

I just thought I would send you a few facts that stood out most to me.  I suppose it’s all relevant & you can compare it to first natural births etc, but let’s just look at these facts as is.  I’m sure we will both agree about what is the best decision for all four of us. Are we happy with this?

1.      The records indicated that one hundred and eighteen out of two hundred and one (118; 58.7%) women were successful in their attempt to have a VBAC. The study results show that 83 records (41.3%) of women reflected an unsuccessful attempt to have a VBAC and thus their neonates were birthed by repeat caesarean section.

2.      Risks for a TOLAC (trial of labour after ceasar), compared to an elective caesarean include an urgent repeat caesarean section and a risk of uterine rupture of 22 to 74 per 10 000 births. Uterine rupture is a very rare complication, but can result in an increased incidence of blood transfusion, hysterectomy, admission to intensive care unit (ICU) and death of the mother.

3.      For baby, the risks associated with a TOLAC include the death of the baby. The incidence of this loss is rare (about 10 per 10 000 which is the same as the risk for women in their first pregnancy), but this risk is increased compared with a planned repeat caesarean (about 1 per 10 000). When uterine rupture occurs the death rate of baby is approximately 50%.

4.      Risk factors that increase the risk of an unsuccessful VBAC are: no previous vaginal birth; body mass index greater than 30; previous caesarean section for abnormal progress of labour; previous preterm caesarean birth; less than 24 months from previous caesarean birth; maternal age of 35 years and older; non-white ethnicity; short stature; birth at or after 41 weeks of gestation; baby’s birthweight greater than 4.0kg; induced labour; dilatation of cervix on admission less than 4 cm; and a male baby.

5.      An elective caesarean has the lowest rate of poor short-term outcomes for mother and baby; a VBAC has the best long-term outcomes; and a failed trial of labour has the highest incidence of negative short- and long-term consequences.

6.      The risk for uterine rupture in an elective caesarean section is about 1 per 10 000 caesareans. Admission to the neonatal ICU for short-term care is increased in caesarean sections.