Vaginal Birth After Cesarean Section
What is a VBAC?
VBAC is the term used to describe a vaginal birth after cesarean delivery. Many women who have had a cesarean section previously can attempt to deliver vaginally in subsequent deliveries. VBAC allows a woman to have the experience of a vaginal delivery if she so desires. It also may decrease the risk of certain health problems related to multiple cesarean deliveries, such as bladder or bowel injury or placenta problems in subsequent pregnancies.
If you and your obstetrician agree that you are a good candidate for a VBAC, you will have a trial of labor after cesarean (TOLAC). This means that you will labor normally as if you were going to deliver vaginally. As can happen in any labor, however, there is still a chance that a cesarean delivery will be necessary. According to studies, approximately 75% of women who attempt VBAC are successful.
Am I a Candidate for VBAC?
According to the American Pregnancy Association, approximately 90% of women who have had previous cesarean section deliveries are good candidates for VBAC. Evidence supports that VBAC can be successful in the right situations. Some of the characteristics that doctors prefer include:
- The current pregnancy is healthy and has no risks.
- Previous successful vaginal delivery, even before a prior C-section.
- Age younger than 35 years. Studies show that women younger than 35 years of age have more successful VBAC deliveries.
- Previous C-section used a low-transverse incision. This side-to-side incision is least likely to rupture during VBAC.
- Two or fewer C-sections occurred before the VBAC.
- The reason for C-section was to protect the baby’s health, not the mother’s.
- There are no uterine anomalies.
- Baby is head down.
Who is not a candidate for a VBAC?
VBAC may not be appropriate in certain situations, such as:
- Advanced maternal age.
- Large fetus size.
- The previous c-section had a high vertical incision.
- Prior uterine rupture.
- Previous uterine surgery, such as removal of uterine fibroids.
- Mother is pregnant with multiple fetuses.
How to Prepare for a VBAC
Women who are pregnant and interested in VBAC are encouraged to talk to their obstetrician about their preferences at their initial prenatal visit. This fosters discussion regarding expectations, concerns, and flexibility within the birth plan from the onset of care. The current healthcare provider needs to have a thorough medical history, including the type of cesarean section that was previously performed.
In addition to maintaining a consistent conversation with the obstetrician throughout pregnancy, a woman can:
- Take a VBAC childbirth class or otherwise learn more about this delivery experience.
- Arrange the VBAC delivery to take place at a hospital or other setting that is fully capable and supportive of this choice.
- Enter labor naturally rather than through induction.
- Work with a doula or midwife that is experienced in VBAC deliveries.
- Manage expectations. A trial of labor after cesarean may result in a cesarean section. Parents should balance their intentions of VBAC with the possibility of complications such as fetal position or umbilical cord wrapping leading to emergency surgery.
Benefits Of VBAC
There are a number of reasons, including wanting to experience a vaginal delivery, for a patient to choose VBAC. Other advantages of VBAC over C-section may include:
- No abdominal surgery
- Shorter recovery period
- Fewer complications
- Less risk of infection
- Less blood loss
VBAC also benefits a woman planning to have several children. A woman who has undergone multiple C-sections may not be a good candidate for vaginal delivery because she has a greater chance of complications. However, a woman who has delivered only one child by C-section experiences fewer risks with each successive vaginal birth.
Risks Of VBAC
Vaginal birth after C-section carries a small risk of uterine rupture at the C-section incision, depending on where the incision was made. A woman who has had a previous C-section with a high vertical incision, which is made down the length of the uterus, may not be eligible for VBAC because this type of incision is more likely to rupture.
VBAC is considered safe for a woman who has had a C-section with a low transverse incision, which is made across the side of the uterus.The majority of C-section deliveries use this type of incision.
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Is it safe to have a VBAC after multiple c sections?
The American Congress of Obstetricians and Gynecologists (ACOG) considers VBAC not only acceptable for women who have had a previous cesarean birth but also the safest option for delivery. This stance applies to women who have had one or two cesarean-sections before attempting VBAC and who also meet additional criteria for a safe, successful vaginal delivery.
Considerations For VBAC
VBAC may not be the best method of delivery if the baby is particularly large or more than one baby is being carried. VBAC has a higher success rate if labor occurs naturally, before or on the due date. However, if the pregnancy goes past the due date, the success rate begins to drop. Other factors that should be considered before VBAC may include:
- Number of previous C-sections
- Prior uterine rupture
- Other pregnancy-related problems
A patient who opts for VBAC needs to remain flexible when it is time for labor and delivery. In most cases, the vaginal birth will proceed as planned, but there are situations that can arise during labor that might increase the risk of complications in a vaginal delivery for the patient or baby. If that occurs, the patient should be prepared to follow the advice of her medical team on how to proceed with delivery.
What does the recovery process look like?
One of the benefits of VBAC delivery is that the recovery from this experience is shorter and easier than cesarean birth. Most patients can go home within a few days, if not the day after their delivery, depending on the particulars of their birth event (episiotomy or complications). The overall recovery from VBAC is very similar to that of a primary vaginal delivery. Patients are much more capable of resuming light activity within days of their child’s birth.