KU Medical Center Has Highest Rate of Vaginal Births after C-Section in Kansas Medicaid Study

But no more. An increasing percentage of women are successful at vaginal birth after C-section (VBAC) at the University of Kansas Medical Center. In a recent study of Kansas Medicaid patients who had previous C-sections and were hospitalized for subsequent deliveries, KU Medical Center had a 70.5 percent VBAC rate. This was the highest rate among 12 hospitals designated as Peer 1 (hospitals located in a metropolitan area with at least 200 beds or within 10 miles of a hospital that meets this criteria).

"A C-section is not a benign operation," said Sebastian Faro, M.D., Ph.D., chair of KU Medical Center obstetrics and gynecology. "A vaginal delivery offers definite advantages to the mother and baby."

Those advantages include:

• Safety of the mother; vaginal births are associated with a lower rate of infection and blood loss than C-sections.
• A hysterectomy, removal of the uterus, is one of the greatest risks of a C-section.
• Safety of the baby; babies born vaginally undergo a natural squeeze during delivery that exerts pressure on the baby's chest to expel fluid from the esophagus, nose, throat and lungs.
• Faster recovery time; mothers do not have the discomfort of abdominal surgery and can eat, drink and move about sooner.
• Shorter hospital stays.

Successful VBAC requires that women who have had a C-section receive counseling so they understand both the risks and advantages of a vaginal delivery, Faro said. He also said that a successful VBAC program meant a physician needed to be present in the hospital during labor, labor and delivery nurses needed to be trained in VBAC and the hospital needed to be staffed by anesthesiologists and pediatricians in the event of a C-section.

The Kansas Medicaid VBAC study, in turn, showed that KU Medical Center had a low repeat C-section rate. Documented reasons for repeat C-sections were abnormal fetal position or fetal distress.

Because of the Medicaid findings, Faro plans to institute a six-month VBAC study at KU Medical Center. If the data for VBACs looks as good as the Medicaid study, he will propose a statewide VBAC protocol to the Kansas Foundation for Medical Care, a state organization under the auspices of the Kansas Department of Social and Rehabilitation Services that monitors quality of state health care. KFMC initiated the statewide repeat C-section/VBAC study.

"If we can get this kind of success rate with VBACs on a large scale, we will definitely reduce health risks to mothers as well as the cost of health care to everyone," Faro said.

Faro believes that the study will have an impact on the primary C-section rate as well as the repeat C-section rate. "Doctors will have to become more patient and be more proactive in labor as we find that not all C-sections are necessary," he said.