Posted by Bill Sandweg on 24 February 2020.
Many women who have had Caesarian sections would like to give birth more naturally. Typically, they did not voluntarily choose to have a Caesarian section during their prior pregnancy or pregnancies. More often than not, some complication of the delivery process required the Caesarian section. They are hoping for better luck this time around but a vaginal birth after Caesarian section (“VBAC”) poses risks to both the baby and the mother.
First the good news. 60 to 80% of mothers who elect a trial of labor after a previous Caesarian section are successful in delivering their babies vaginally. A vaginal delivery avoids the surgical risks which accompany every procedure. It gets mom back to her normal life more quickly and it increases the likelihood that future babies can be delivered vaginally.
On the other hand, VBAC does present some risks to the baby and the mother. Perhaps the most significant risk is uterine rupture. The wall of the uterus is weakened where it was cut open during the earlier Caesarian section. The wall is surrounded by powerful muscles, which, during childbirth, contract to push the baby through the birth canal and into the world. Sometimes the power of those muscles overwhelms the strength of the uterine wall and it ruptures. When that happens, the mother begins to hemorrhage and the baby loses its oxygen supply.
Doctors who are caring for patients undergoing a trial of labor after a Caesarian need to be alert for signs of uterine rupture. A delay in recognizing and treating a uterine rupture can cost the life of both the baby and the mother.
You would think that obstetricians who have been trained about the risks of VBAC, the signs and symptoms of uterine rupture and what to do in the event of a rupture would be able to promptly recognize a rupture and deal with it. While most of the time you would be right, sometimes you would be wrong. Sometimes, obstetricians are oblivious. Sometimes it is the nurses who are oblivious or are just not as well-trained as they should be and who fail to appreciate the significance of what is happening right before their eyes. Either way, it is bad news for the mother and her baby.
The good news for mothers laboring after a Caesarian is that, even with a uterine rupture, the baby can be saved and delivered both alive and healthy. Babies are incredibly resilient. Mom can be successfully treated as well. The bad news is that there is only a short period of time in which to recognize the uterine rupture and deliver the baby. If that period of time is exceeded, the baby will either be born dead or will be born with deficits caused by the lack of oxygen following the uterine rupture.
If you have lost a baby due to uterine rupture while laboring following a Caesarian section, you should consult with a qualified medical malpractice lawyer. It may be that everything that could have been done was done. On the other hand, it may be that someone or many someones were asleep at the switch and that your baby did not need to die. A good medical malpractice lawyer should be able to discover which it was.