May 24, 2011 (Tuesday) - VBAC

An anaemic lady who has just given birth. The diagnosis was a new one to me – “VBAC”. This stands for “vaginal birth after caesarean”.

Specimen Results Entry Bleeding, Profusely                               DOB  18/08/1983 Sex F Pat No 222333       Received  11:04 Address   Her house                       24/05/2011 Diagnosis VBAC Specimen No   :  AW172400M               Selected Auth Level : S  HB     8.7    F000 |MONO   0.9    F000  WBC    13.2   F000 |EOS    0.0    F000  PLT    157    F000 |BASO   0.0    F000  RBC    3.37   F000 |~F1   ^FILMW  F008  HCT    0.270  F000 |                    MCV    79.2   F000 |                    MCH    25.8   F000 |                    MCHC   32.6   F000 |                    NEUH   10.5   F000 |                    LYMPH  1.8    F000 |

I naively assumed that having had a caesarean section for one birth rather forced the patient into having caesarean sections for subsequent pregnancies. I was wrong.

It would seem that this was the general opinion for much of the twentieth century, but in the 1980s and 1990s there was a move away from that school of thought, and normal deliveries would be attempted. More recently opinion has changed, and normal deliveries in such cases are only attempted given the availability of immediate surgical intervention. Having said that, some 60-80% of attempted VBAC are successful, therefore reducing the amount of caesarean sections that would have been performed in such cases.

Having said that, sometimes things are not as simple as this might seem – this case had a pre-delivery Hb of 12.4g/dl. Clearly there has been post-partum haemorrhage.