Women who have previously given birth by cesarean section (C-section) often hope to experience a natural vaginal birth with their next child. In the medical community, this is known as a Vaginal Birth After Cesarean Delivery, or VBAC.
Many women choose to attempt VBAC, and most successfully experience vaginal birth without any complications. There is, however, a risk of injury to both mother and child. While these injuries are rare, they can be catastrophic if things go wrong.
There’s a lot to know about VBAC, and the decision of whether to pursue one should always be made carefully after deliberation with your doctor.
In today’s article, we explore some of the risk factors that make VBAC injuries more likely, the duties doctors have to keep their patients safe, and what your legal rights may be if you or your child has been injured during a VBAC delivery.
Risk Factors a Doctor Should Consider When Evaluating VBAC
The decision of whether to pursue a VBAC should always be made carefully — even for mothers who are perfectly healthy and who do not exhibit any risk factors.
However, for women who have one or more risk factor, VBAC is generally not advised.
Risk factors include:
- Maternal obesity
- Fetal macrosomia (a baby who is larger than average)
- Multiples pregnancy (e.g. twins, triplets, etc.)
- Baby is in breech position
- Maternal high blood pressure, eclampsia, or preeclampsia
- Maternal diabetes
- Maternal blood clotting disorders
- Certain other maternal health conditions (including genital herpes)
- Previous C-section was less than two years ago
- No history of successful vaginal deliveries
- The health conditions that led to the previous C-section are still present
- Complications with the uterus, placenta, or umbilical cord
- History of uterine rupture
- History of difficult pregnancy, labor, or delivery (or history of fetal distress)
- Previous C-section was accomplished with a high vertical (classical) incision
- History of unsuccessful TOLAC (see below)
- More than one previous low vertical/low transverse incision
VBAC Injuries: The Risk of Uterine Rupture
If you’ve had a C-section in the past, there is likely a scar on your uterus. This scar is a result of the cesarean section procedure itself. In many of today’s C-sections, the scar is horizontal and located on the lower part of the uterus; in others it has a different shape (the classic C shape, for example) and may be located in a different part of the uterus.
Regardless of the type of scar, the location of the incision, or how long it’s been since your C-section, in any VBAC, there is some risk of injury.
Specifically, one of the gravest risks of VBAC is that of uterine rupture. During delivery, your uterine contractions can put a great deal of pressure on your uterine scar. As you push to deliver the baby, this adds pressure too.
All this pressure can cause the scar to separate and then rupture.
A uterine rupture is a life-threatening medical emergency for the mother and the child. It can cause the baby to spill out from the womb into the abdominal cavity, where its oxygen supply is cut off. Doctors may have mere minutes — or less — to perform an emergency C-section and save the baby’s life.
Meanwhile, the rupture can also cause life-threatening internal bleeding in the mother’s body. It may also cause the placenta to be expelled into the abdomen. Emergency intervention is required to prevent maternal death.
Unsuccessful VBAC: TOLAC Injuries
In some cases, it becomes apparent that an attempted VBAC is not going to be successful. For example, the uterine scar may show early signs of separation prior to rupture. Doctors may also decide to abandon VBAC if either the mother or the baby begins to show signs of distress during labor. And certainly, in the event of a rupture, VBAC should be immediately abandoned in favor of an emergency C-section.
An unsuccessful VBAC is referred to as Trial of Labor After C-Section, or TOLAC.
TOLAC presents its own risk of injuries, including infection and/or negligent C-section delivery. (Resorting to C-section at the last minute on an emergency basis increases the likelihood of complications or mistakes during C-section.)
Moreover, the attempted vaginal birth may cause significant damage to the mother’s reproductive organs or to the baby’s body, even if the C-section is ultimately successful.
A Doctor’s Duties in TOLAC / VBAC Deliveries
Doctors, nurses, hospitals, and other medical professionals owe their patients a high duty of care. Among other things, your doctors should clearly explain to you the risks and potential complications of VBAC, and they should only proceed with a TOLAC / VBAC after getting your full, informed consent.
Doctors should screen their patients carefully and take a detailed medical history in order to identify any potential risk factors that might make VBAC more dangerous. They should exercise their expert discretion when determining whether a patient is a good candidate for VBAC and should always abide by the established standards of their profession.
During labor and delivery, doctors should know the warning signs of fetal distress, uterine scar separation, uterine rupture, and other complications.
Before proceeding with an attempted VBAC, doctors should ensure that a C-section can be performed on a moment’s notice within the same facility in the event of an emergency.
Doctors should also make every reasonable effort to avoid the risk of infection, C-section errors, and other complications associated with TOLAC and VBAC injuries.
Any failure to meet these duties may result in liability for the responsible doctor, hospital, nurse, wife, or care provider.
Talk to an Indiana Birth Injury Lawyer at Doehrman Buba Ring
If you or your child has suffered injury after a VBAC or TOLAC delivery and you believe a doctor or hospital’s negligence might have been a factor, you may be entitled to financial compensation for your damages.
Before you accept a settlement from a hospital or insurance company, we urge you to contact our office to talk about your options with an experienced Indiana birth injury lawyer. You may be entitled to more than you realize.
We will not charge you a fee unless we are successful in recovering compensation for your claim. To learn more, please contact Doehrman Buba Ring and schedule a free, no-obligation consultation today.