VBAC Delivery

VBAC, or vaginal birth after cesarean, is when a mother is able to delivery her baby vaginally after delivering a previous baby via C-section. In the U.S., one in three women give birth by Cesarean each year. 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 can be a safe alternative to a routine repeat cesarean.

Many women have faced the difficult experience of having to give birth via C-section unexpectedly. Such women often worry about getting pregnant again, fearing they might not be able to give birth vaginally. A C-section can take an emotional and physical toll on a woman who wants to give birth again. Cesarean birth can be a life-saving procedure for a mother and her baby, but can also put healthy pregnant women at risk for medical and psychological complications.

If an expectant mother and her doctor agree to try VBAC, a “trial of labor” ensues. TOLAC (trial of labor after cesarean) involves going into labor with the intention of delivering vaginally. It’s hard to say whether or not the VBAC will work until labor begins, but studies show that as many as six out of ten women who undergo a “trial of labor” will deliver vaginally. It’s extremely important that you discuss this issue with your doctor. You may not be able to deliver your baby at the hospital you intended to use if they are not equipped properly. Talking with your healthcare provider early in the pregnancy can prevent future problems and help you put together a birth plan.

Am I a Candidate for VBAC?

Generally, if an expectant mother has only had one previous Cesarean delivery, VBAC may be a safe option, but this can depend on other factors. You may be a candidate if:

  • You have had one prior C-section, performed with a low-transverse uterine incision (as most are, but sometimes medical records are needed to confirm this)
  • The hospital is equipped with staff and tools to perform an emergency C-section if needed
  • There is no reason for a Cesarean birth with this pregnancy
  • The reason for the previous Cesarean does not exist with this pregnancy
  • The baby is of normal size
  • The baby is head-down
  • You have no known major medical problems such as diabetes or high blood pressure
  • You’re not carrying twins

Advantages of VBAC

For women who are over the age of 35 or who have a large fetus, or if the pregnancy has lasted beyond 40 weeks, there are risks involved with vaginal delivery. Still, VBAC helps women avoid additional scars on the uterus, which is important for women who want to get pregnant again. Plus, more scars on your uterus can increase the potential for 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 for recovery.

If you are a candidate for VBAC and decide to attempt it, the chances are about 60 to 80% that you will be able to deliver vaginally.

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. Although it’s an uncommon occurrence (it happens a little less than 1% of the time), it does happen and it can become a serious problem for both mother and baby. Because of this risk, VBAC is only offered by hospitals that are completely equipped to do a rapid 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 in Labor and Delivery

If you and your doctor choose VBAC for this pregnancy, your labor will be mostly normal. Your healthcare team will want to monitor you more closely, but during early labor you are able to move around as much as you want. When labor begins, VBAC restrictions kick in. You will need to remain in bed for continuous fetal heart monitoring. If you are taking too long to begin labor, labor may be induced, but most doctors try their best to avoid inducing VBAC labor. You may not be allowed any oral intake (food or liquid), since there is a chance of emergency C-section during a VBAC attempt.

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

This page was last updated on 06/2017

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