Dr. Novoa's Opinions and Conclusions Regarding VBAC
  1. VBAC should be encouraged in patients with one previous Cesarean Section (C/S) and considered in patients with two previous Cesarean Section (C/S) as long as there are no other contraindications.
  2. The benefits of a VBAC are significant as compared to the potential complications associated with a repeat C/S.
  3. The recommendation of "once a cesarean, always a cesarean" is not valid and is not supported by the literature.
  4. The risk of an Uterine Rupture, which is one of the most serious complications of a failed VBAC, occurs between 0.5-1%.
  5. The risk of materal death associated with a uterine rupture is extremely low, reaching almost 0%.
  6. The risk of fetal death associated with a uterine rupture is between 3-6%.
  7. Current hospital policies either banning VBAC outright or restricting VBAC to a single previous C/S is not supported by the literature and can compromise both the health and well-being of both mother and baby.
  8. Current hospital policies requiring a physician to be "immediately available" or "in-house" (in the hospital) during the entire labor process has not been shown to improve the overall outcome of the VBAC delivery and has instead lead to the reduction of routine VBAC deliveries to less than 10%.
  9. Proper Informed Consent regarding the VBAC requires that your physician provide information regarding the most current recommendations on VBAC from institutions such as the National Institutes of Health (NIH), the Centers for Disease Control (CDC), the United States Department of Health and Human Services, and the American Congress of Obstetricians and Gynecologists (ACOG).
  10. Each repeat C/S increases risks of complications, especially after four C/S and should be discussed especially in women considering having large families.
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