For many years, obstetricians were guided by the principle of “once a cesarean, always a cesarean.”
Between 1970 and 1995, the rate of delivery by cesarean section was reportedly between 20% and 25% on a national basis. Consequently, more and more pregnant mothers who previously delivered a child by cesarean section were confronted with the question of whether it was reasonably safe to attempt a vaginal delivery, or have another cesarean delivery, in their subsequent pregnancies.
In 1988, the American College of Obstetricians and Gynecologists (“ACOG”) issued the first of its committee opinions and clinical practice guidelines recommending VBAC in appropriate cases. According to ACOG, a successful VBAC carried benefits of safety — by eliminating the risks of surgery — and economy — by eliminating costs of cesarean delivery and extended postoperative stays.
Because of the purported cost savings associated with VBAC deliveries, many health insurers and third-party payors mandated a “trial of labor” and attempted VBAC for every pregnant patient — even in those cases where VBAC would not be considered suitable by the managing obstetrician.
Unfortunately, VBAC carries a number of grave and potentially fatal risks, many of which are not fully explained or discussed with the pregnant mother. These risks include the dangers of uterine rupture — a potentially life threatening condition for both mother and baby, in which the forces and stresses of uterine contractions associated with the attempted vaginal delivery cause the uterus to tear open, potentially expelling the unborn fetus into the mother’s abdomen.
In such cases, maternal and fetal death, or fetal asphyxia and long-term neurologic impairment, are common consequences, particularly in those cases where medical personnel fail to appreciate the risk of uterine rupture or fail to act expeditiously when a uterine rupture occurs.
Because of these substantial risks and their dire consequences, many experienced and careful obstetricians have questioned whether VBAC is an appropriate and reasonably safe mode of delivery for many patients who have had prior cesarean deliveries. Unfortunately, perhaps as a result of inexperience or the economic pressures imposed by insurers and third-party payors, many obstetricians encourage their pregnant patients to undergo VBAC deliveries and fail adequately to appraise them of the reasonably foreseeable risks and alternatives, including repeat cesarean delivery.
The Law Firm of Dugan, Babij, Tolley & Kohler, LLC has extensive experience in representing families whose loved ones have been injured as a result of uterine rupture and ill-advised VBAC deliveries.