If you have previously had a baby who was delivered by caesarean birth and you are now expecting another baby, your midwife or specialist childbirth doctor (obstetrician) may offer you the option for your next baby to be born by vaginal birth after caesarean (VBAC) delivery.
VBAC can avoid the need for a caesarean section and provide a more natural birth experience for low-risk mothers and babies, but it is not suitable or safe for those with certain risk factors and in birthing environments without appropriate monitoring, clinical staffing and emergency facilities.
Women who are considering a vaginal birth after a previous caesarean section should be fully informed by a senior obstetrician about their own level of risk for VBAC labour and delivery, and the VBAC labour must be closely monitored by their maternity team.
Negligent planning, monitoring and management of VBAC labour can result in life-threatening injury to both mother and baby from uterine rupture.
Boyes Turner’s birth injury and maternal birth trauma claims solicitors have secured life-changing compensation settlements for injured mothers and babies in claims arising from failure to counsel the mother adequately about her risks from VBAC labour, negligent monitoring and management of the labour, and delays in responding promptly to signs of hyperstimulation or rupture of the mother’s uterus, such as by expediting delivery of the baby.
What information should be given to pregnant mothers about VBAC?
The Royal College of Obstetricians and Gynaecologists (RCOG) have issued guidelines which obstetricians and maternity units must follow when considering, informing or supporting a mother through a VBAC labour.
Before the decision is made about whether an expectant mother should have a trial of VBAC or a planned caesarean birth, the mother must be counselled by a senior obstetrician about the risks of VBAC based on her personal circumstances and risk factors. The mother can then make an informed decision about the mode of delivery.
How should a VBAC be conducted?
Vaginal birth after caesarean (VBAC) must always carried out as a ‘trial of labour’, so that if at any time the mother or baby are considered to be at risk from uterine scar rupture, obstructed labour, fetal distress from oxygen deprivation or maternal compromise, immediate arrangements can be made to deliver the baby by emergency caesarean section.
The RCOG guidelines specify that trial of VBAC must take place in a delivery suite which is equipped for continuous intrapartum care and monitoring, with facilities for immediate caesarean delivery and advanced neonatal resuscitation.
The fetal heart rate must be monitored electronically (using a CTG monitor) from the onset of regular contractions throughout the VBAC labour, so that any signs of maternal or fetal compromise, obstructed labour or uterine scar rupture are detected as early as possible.
It is also a mandatory requirement of the RCOG guidelines that the mother’s condition and the progress of the labour are regularly monitored by one-to-one care.
What causes hyperstimulation of the mother’s uterus in labour?
Drugs such as Syntocinon (a synthetic oxytocin hormone) are often used to induce or augment (speed up) labour. Syntocinon is a very powerful uterine stimulant drug, which is given in small doses via a drip. Excessive or inappropriate use of Syntocinon can cause hyperstimulation of the mother’s uterus with contractions occurring with excessive frequency and strength. This can sometimes lead to uterine rupture, particularly where the mother’s uterus has already been weakened by a previous caesarean or surgical scar.
When drugs are being used to augment labour the fetal heart rate must be continuously monitored electronically (using a CTG monitor) from the onset of regular contractions throughout the labour, so that any signs of maternal or fetal compromise, obstructed labour or uterine scar rupture are detected as early as possible.
The midwife should also be monitoring the frequency and strength of contractions to avoid hyperstimulation of the mother’s uterus and adjust the dosage of the Syntocinon drip or stop the uterine stimulant drugs altogether.
What happens if there is a uterine rupture in labour?
In many cases where there is uterine rupture in labour, the scar breaks down without any apparent maternal symptoms and is only diagnosed later during surgery to deliver the baby. The RGOG guidelines emphasise the importance of considering the whole clinical picture (including the mother’s condition) when assessing maternal and fetal wellbeing during a trial of labour.
Suspected rupture or dehiscence (re-opening) of the uterine scar is a medical emergency requiring urgent caesarean section and neonatal resuscitation. Delay in recognising signs of uterine rupture, carrying out an emergency caesarean section and providing the baby with neonatal resuscitation can result in life-threatening injury to the mother from major obstetric haemorrhage (bleeding), and oxygen deprivation to the baby causing permanent disability from hypoxic brain injury, or intrauterine or neonatal death.
Recent cases
Boyes Turner’s birth injury solicitors are experienced in birth injury claims involving VBAC, uterine rupture and hyperstimulation.
Recent successful claims include:
- multi-million settlement for a teenage boy who suffered a hypoxic brain injury at birth after multiple maternity mistakes during his mother’s VBAC labour led to uterine rupture;
- £18.7 million settlement for a teenager with HIE birth injury and cerebral palsy caused by negligent hyperstimulation of his mother’s uterus in labour;
- £14.6 million settlement for a young man with HIE brain injury and cerebral palsy caused by negligent hyperstimulation of his mother’s uterus during labour and delivery;
- compensation settlement for a mother whose baby was stillborn after negligent maternity care during her VBAC labour led to hyperstimulation and uterine rupture;
- £4.7 million settlement for a girl who was left with severe quadriplegic cerebral palsy from HIE brain injury as a result of negligent management of her mother’s VBAC labour;
- £3.3 million settlement for a girl who was left with severe cerebral palsy, epilepsy, learning and visual disability as a result of negligent maternity care during her VBAC birth.
If your child or their mother suffered severe birth injury as a result of medical negligence, or you have been contacted by HSSIB/MNSI or NHS Resolution , you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
Written by
Susan Brown
Susan leads the medical negligence team and is recognised as a leading lawyer in the UK, specialising in high value brain injury and cerebral palsy cases.
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