Decision Focus: Vaginal Birth After C-Section (VBAC)

Written by admin on June 24, 2011 – 10:41 am

You had a cesarean section with your first baby. Now you’re pregnant again, and wonder if you will need a C-section this time too. You would like to try a vaginal birth but don’t know if it’s safe for you and the baby.

Doctors used to believe that once a woman had a C-section, she would need one for all later births. But now it’s known that many women can attempt a trial of labor and may safely deliver vaginally even though they have had a C-section in the past. This is called vaginal birth after cesarean section, or VBAC.

Doctors call it a trial of labor because a woman is allowed to start labor and have contractions with the goal of a vaginal birth. But if labor does not progress normally, or if there are any signs of problems with the mother or baby, a C-section is done.

Is VBAC right for me? You and your doctor can decide if VBAC is a good option for you. Some medical considerations need to be factored in to this decision.

The decision to try VBAC is also a matter of personal preference. Some women want to try a vaginal birth because they had a hard time recovering from their first C-section. Others hesitate to try VBAC because they fear complications or they are more at ease knowing what to expect.

Criteria for VBAC Deciding whether or not you want to try VBAC can be tough. First you need to find out whether a VBAC is right for you. You may be able to have a VBAC if you meet certain conditions, including:

You’ve had a previous low-transverse C-section. (This is a low, horizontal incision in the uterus and not a vertical incision on the uterus.)
You have no other uterine scars from previous births or surgeries.
Your pelvis seems large enough to deliver a baby vaginally.

Experts from the American Congress of Obstetrics and Gynecology (ACOG) say that it also may be OK for the following women to attempt a trial of labor after previous cesarean delivery. Those who:

Had two previous low-transverse C-sections
Have an unknown type of uterine incision, unless your doctor suspects that it was not a low-transverse one
Are pregnant with twins and had only one prior C-section, and that C-section involved a low-transverse incision

Benefits of VBAC You may want to try VBAC for a number of reasons. Some women may want to experience a vaginal delivery. Other reasons include:

You can probably expect a shorter hospital stay with a shorter and easier recovery.
There’s less risk of infection, blood clots and other complications of surgery.
Your partner will be able to be more involved in the birth process.
If you are planning more children, you may be able to deliver them vaginally, too.

Risks of VBAC The main concern you might have about VBAC is the possibility of the previous C-section scar tearing. This is called uterine rupture, and it can be very serious for the mother and baby. According to estimates from the ACOG, this happens in less than 1 in every 100 VBACs.

There is also a chance that you may have to go through hours of labor and still end up having a C-section. Doctors say that 60 percent to 80 percent of women who try VBAC are successful. You have a better chance of having a successful VBAC if:

The reason for previously needing a cesarean delivery – such as a breech baby – is not occurring in this pregnancy
There are no major medical problems with you or the baby (this includes problems with the placenta, high blood pressure or gestational diabetes)
The baby is of normal size
The baby is in the right presentation (head down)
You’ve given birth vaginally before

If you are past your due date, you may still be able to attempt a trial of labor. But the chances of having a successful VBAC are less if labor is induced.

Note that all methods of childbirth have risks and benefits. Learning more about each of your choices along the pregnancy and delivery path can help you feel at ease and more confident about what to expect. Talk to your doctor to learn more about VBAC and other means of childbirth.

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