VBAC – Vaginal Birth After Cesarean Delivery

VBAC or vaginal birth after cesarean, is when a mother is able to delivery her baby vaginally after she delivered her previous baby via c-section. After recent studies were conducted, it was found that 1 in 3 women give birth by cesarean each year. Even more recent studies show that the majority of these women (up to 90%) are candidates to give birth naturally or vaginally after a previous cesarean delivery. For women who are good candidates and desire to do so, VBAC is a safe alternative to a routine repeat cesarean.

Many women have faced the difficult dilemma of having to give birth via c-section unexpectedly. Many of these same women have stressed over whether or not to get pregnant again, fearing they wouldn’t be able to give birth vaginally. It can take an emotional and physical toll on a woman who wants to give birth again. C-sections can be a life-saving procedure for a mother and her baby, but still, cesarean births can put healthy pregnant women at risk for medical and psychological complications. Still, unless it is an emergency, most women have the choice of which child birth option is best for her and her baby.

If an expectant mother and her doctor agree to try VBAC, a ‘trial of labor’ ensues. TOLAC (trial of labor after cesarean), means you go into labor with the intent of delivering vaginally. It’s hard to say whether or not the VBAC will work until labor begins, however studies show that as many as 6 out of 10 women who try a ‘trial of labor’ deliver vaginally. It’s extremely important that you discuss this issue with your doctor. You may or may not be able to deliver your baby at the hospital you intended too if they are not equipped properly. Talking with your health care provider early in the pregnancy can prevent future problems, as well as assist you with a birth plan.

Am I a Candidate for VBAC?

Generally, if an expectant mother has only had one previous cesarean delivery, than VBAC is a safe option. Other factors come into play, however, and include:

• One low, side-to-side scar from a c-section
• If you have delivered vaginally before, yet have had two previous cesareans
• The hospital is equipped with staff and tools to perform an emergency c-section if needed
• There is no known reason for a cesarean birth with this pregnancy
• If the reason for the previous cesarean is not repeated with this pregnancy
• The baby is of normal size
• The baby is head-down or breech
• You have no known major medical problems such as diabetes or high blood pressure
• If you’re not carrying twins

Advantages of VBAC

Some of the advantages of having a VBAC are for women who are older than 35, who have a large fetus, or if the pregnancy has lasted beyond 40 weeks. However, these same things also lower the chance of being able to deliver vaginally. Still, VBAC helps women avoid additional scars on the uterus, which plays an important role for women who want to get pregnant again. Plus, the more scars you have on your uterus can cause an increase for potential problems with future pregnancies. Many women also experience less pain with VBAC, as well as shorter recovery periods and less time in the hospital. The risk of infection also decreases, which is crucial when recovering.

Disadvantages of VBAC

The biggest disadvantage of VBAC is the risk of opening a previous scar or a uterine rupture at the site of the previous incision during delivery. It’s a very rare occurrence, however it does happen and it can become a huge problem for both mother and baby. It’s because of this risk why VBAC is only offered by hospitals who are completely equipped to do an emergency c-section if necessary.

When it comes to the ‘trial of labor’, there’s always a chance that an emergency c-section may be needed to complete the delivery. The risk of infection is slightly higher if you try to give birth vaginally, and end up having a c-section.

VBAC Labor and Delivery

If you and your doctor choose VBAC for this pregnancy, do not worry about many changes from a normal labor. Your health care team will want to monitor you closer, but during early labor you are able to move around as much as you want. When labor begins, VBAC restrictions kick in. This is where you will need to remain in the bed for continuous fetal heart monitoring. If you are taking too long to begin labor, you may be induced. Inducing labor for VBAC is varied among medical professionals. In most cases, doctors try their best to avoid inducing VBAC labor, while others are willing to slowly begin using oxytocin once the cervix is soft and dilating (opening).

Most women who choose VBAC can use pain medications if desired after the cervix has opened to 3-4cm. Typically, local anesthesia, epidurals, sedatives and opioids (narcotics) can be used to relax you and relieve pain.