Vaginal Birth After Cesarean

• Birth Injury
• Vaginal Birth After Cesarean (VBAC)

Vaginal Birth After Cesarean (VBAC) & Complications

The goal of labor and delivery is to produce a healthy baby. Sometimes things don’t go as planned, and the mom has to have a cesarean delivery (C-section) instead of a natural or vaginal birth.

After delivering a child by c-section, some mothers may decide to deliver by a method called “vaginal birth after cesarean” (VBAC) during subsequent pregnancies. This decision should not be made lightly. While this method offers the benefit of not having to undergo surgery, there are very serious risks accompanying a VBAC.

One of the more severe consequences of a failed VBAC is uterine rupture, which can endanger the lives of both mother and baby.

Obstetricians have a responsibility to counsel their patients on the risks and benefits of VBACs. They might start by explaining how a Trial Of Labor After Cesarean (TOLAC) works.

From TOLAC to VBAC

A pregnant woman may choose to commence a TOLAC instead of scheduling an elected cesarean delivery (“C-section”). Her doctor and other medical professionals on her team should monitor her closely during delivery. Specifically, they need to watch for signs of:

• Uterine rupture
• Bleeding
• Maternal labor complications
• Fetal distress

A successful TOLAC ends with a successful VBAC. But sometimes, a TOLAC should not even be attempted.

Eligibility for Attempting a VBAC

When doctors counsel mothers who want to attempt a TOLAC, they must review the mother’s medical history. Some events and conditions could make TOLAC unacceptably dangerous. However, the expectant mother will not know this unless her doctor (obstetrician or maternal-fetal specialist) or midwife explains the dangers to her.

Generally, the following conditions greatly reduce or eliminate eligibility for TOLAC and VBAC:

• Classical, T, or J-shaped uterine incisions: These types of incision can increase the risk of uterine rupture. They may have been done during prior C-sections, uterine surgeries, or open fetal surgery
• Prior uterine ruptures: Women with prior uterine ruptures are less likely to have a successful TOLAC. The mother could be in danger of having another rupture, which also puts her baby at risk for serious birth trauma
• Macrosomia: Some mothers with large babies (more than 4000 grams or almost 9 pounds) are more at risk for uterine rupture during TOLAC
• Pregnancy of more than 40 weeks: After 40 weeks gestation, women are more likely to be induced. Induction alone does not cause uterine ruptures but can be hazardous when combined with other factors
• Short interval between C-section and subsequent pregnancy: It’s recommended that women who deliver by C-section should wait at least 18 months before conceiving another child. This gives the uterus more time to heal completely

Generally, pregnancies and babies at risk for any reason could make TOLAC difficult and VBAC unlikely.

Risks to Mother and Baby

The primary risk for the mother is uterine rupture. The uterus is the organ that holds the placenta, amniotic sac, and baby. A scarred uterus – one that has had previous surgery or injury – can split partially or completely.

The mother faces blood loss, transfusions, and shock during a uterine rupture. Her baby must be delivered immediately by emergency Cesarean delivery (C-section) to protect both mother and baby. In extreme cases, the mother may need a hysterectomy (removal of the uterus) or may die from blood loss.

The baby may be partially or fully expelled from the uterus into the mother’s abdomen. Blood and oxygen will be reduced, which can cause a severe brain injury called hypoxic-ischemic encephalopathy (HIE). Unless delivered immediately by emergency C-section, the baby could die. And babies with HIE often have lifelong disabilities, including seizure disorders, cognitive difficulties, delayed developmental milestones, and cerebral palsy.

Managing Vaginal Birth After Cesarean (VBAC)

Doctors (including obstetricians) have a duty to assess the mother’s condition and review her history when discussing TOLAC and VBAC. Factors should be considered in context with each other and the overall health of mother and baby.

The mother makes the ultimate decision, but she needs to understand all the risk factors that complicate TOLAC. Primarily, it’s crucial to acknowledge that not all women are candidates for TOLAC. The risk factors mentioned above should be explained during counseling.

Also, a mother may decide on TOLAC and VBAC early in her pregnancy. Her doctor should reassess periodically to ensure that she is still a candidate.

Most importantly, TOLAC must be done at a hospital that can perform emergency C-sections. If a mother’s planned birth setting cannot handle the complications associated with TOLAC and VBAC, a planned C-section is always the safer option.

Where Medical Professionals Can Go Wrong

Protecting a mother and her baby should be top priorities for doctors, nurses, medical staff, and hospitals. When they fail to do so, babies can sustain life-threatening birth injuries with life-long consequences.

Medical professionals can be negligent or commit medical malpractice in several ways, including:

• Failing to counsel a patient on the risks associated with TOLAC and VBAC
• Failing to get informed consent from the mother before attempting VBAC
• Attempting TOLAC in a hospital that is not equipped to do emergency C-sections
• Missing signs that the mother is having complications like a uterine rupture
• Failing to monitor mother and baby during labor
• Misinterpreting or ignoring signs of fetal distress

When doctors, nurses, hospitals, and other healthcare providers are negligent, babies and their families suffer.

Is Your Child’s Birth Injury after a VBAC the Result of Medical Malpractice?

The parents of children who suffered birth injuries after a uterine rupture during a VBAC want answers. They want to know what happened to harm their child’s brain. Should the doctors have never attempted a VBAC and TOLAC? Was the hospital where the VBAC and TOLAC was attempted not properly equipped? Did the medical providers fail to provide for an emergency c-section or fail to recognize signs of fetal distress and to respond to in a timely manner?

Our dedicated birth injury lawyers want to help you find those answers.

We diligently investigate the facts, including a detailed examination of the prenatal records to determine if a VBAC or TOLAC should have ever been attempted. We investigate whether the hospital was properly equipped and whether proper steps were taken prior to the VBAC or TOLAC. We carefully study the fetal heart rate monitoring strips and labor and delivery records for signs of fetal distress or impending uterine rupture.

If this review shows the medical providers did not diagnose or respond to fetal distress, we hold responsible parties accountable by pursuing medical malpractice claims against them. The compensation our clients receive helps them pay for their child’s current and future medical treatment, assistive technology and equipment, attendant care, and the other expenses associated with caring for a child with brain injuries, seizure disorders, and cerebral palsy.

Sometimes families are afraid to talk to lawyers about their child’s case because they worry there is a fee. There is never a fee unless and until we make money recovery for our clients.

Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?

The only way to find out if you have a birth injury case is to talk to an attorney who understands birth injury.

At Miller Weisbrod, a team of committed professionals uses our detailed case review process to assess your potential claim. They start by learning more about you and your child. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.

If we feel medical malpractice was present, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.

Contact Miller Weisbrod Olesky