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VBAC (Vaginal Birth after Cesarean)

Jan 13, 2014

In the initial years when C-sections were introduced, doctors would not allow women to have normal vaginal deliveries for their future children after a C-section. However, modern techniques now allow women the freedom to have a Vaginal Birth after Cesarean (VBAC), with a current success rate of 75%.

Cesareans are usually allowed in complicated cases and if your complication is due to a core condition or a recurring complication, then the chances of a VBAC are reduced or even eliminated. The following article contains detailed information on VBAC including risks, procedures and preparation.

What Makes You a Good Candidate for VBAC?

If you do not have any underlying medical conditions that could cause complications, then opting for VBAC should not be an issue and your delivery should be a successful one. Factors that can decrease your likelihood are:

If you have never had any general surgery around or on the uterus, for example myomectomy (for the removal of fibroids).
Your uterus had never experienced a rupture.
If your previous cesarean was a low traverse horizontal cut as opposed to a vertical one in your upper uterus (which is known as ‘classical’ or ‘T-shaped’), then you should be fine. The latter can increase your chances of a rupture, thus making VBAC risky. Also, keep in mind that the scar on your stomach does not necessarily replicate the one on your uterus, so ask your doctor for all your previous information before proceeding.
If you don’t have any previous medical issue such as a placenta previa or a large fibroid that can increase the likelihood of complications.
If your pelvis is not large enough to allow a VBAC, which in most cases can be determined with a physical examination.
If there is an experienced doctor available at the hospital to monitor you during your labor and delivery, in case an emergency C-section needs to be performed. In addition, reliable anesthesiologists and other trained medical staff need to be available for extreme situations as well.

Factors that reduce your chances of a successful VBAC include:

If you are an older woman, then there is a much lower chance of having a successful VBAC, so age can work against you.
Being overweight can also cause complications so your body mass index (BMI) needs to be within the normal range.
If the baby is over 8.8 pounds or 4000 grams.
If your pregnancies are within 18 months of one another.
If your pregnancy period exceeds 40 weeks.
If either you or your baby are unhealthy and the pregnancy is not proceeding normally.
If your labor needs to be induced and does not occur naturally.
If you have previously never had a natural vaginal delivery that was successful.

Benefits of VBAC (Vaginal Birth after Cesarean)

Benefits	Description
Less complicated	A C-section has a high chance of resulting in an infection or extreme loss of blood. VBAC lessens those risks, leaving you with a healthier body. Keep in mind though that when an emergency C-section is performed, your risk of infection is increased as opposed to a scheduled C-section.
Partaking in the delivery process	After a VBAC, women get to instantly hold and feed their baby, which makes them feel an instant connection that they would not experience after a cesarean.
Recovery	C-sections are both costly and take longer to recover from. VBAC is a more natural process that allows patients to resume their lives faster and stay at the hospital for a short time.
Pregnancies in the future	Repeated C-sections are more complicated each time and for people that are planning to have multiple children, this is very problematic. On the other hand, VBAC gets easier with every child, increasing its appeal.

Risks of VBAC (Vaginal Birth after Cesarean)

Risks	Description
Failed Labor	In some cases, about 25%, the baby cannot take the pressure that comes with labor and a C-section has to be performed instead.
Urine Infection	When you have an emergency C-section as opposed to a planned one, your chances of a uterine infection are greatly increased.
Rupture	In some cases the uterus tears due to a previous C-section. If your uterus ruptures, then an emergency C-section is performed. This increases the chances of blood loss, infection, brain damage to the baby and in some cases even death.
Lack of reliable staff	In extreme cases, especially at hospitals that are ill equipped for an emergency C-section, a hysterectomy (removal of the uterus) is performed to stop the bleeding, meaning that you can never conceive again.
Pelvic floor problems	The pelvic floor muscles are what support your uterus and sometimes the increased weight and strain can weaken them, causing the muscles to stretch abnormally during a VBAC. This results in temporary urinary incontinence.

How to Prepare for VBAC (Vaginal Birth after Cesarean)

If you are planning on going for a VBAC, then here are some points to increase your chances of success.

Preparations	Description
Educate yourself	Talk to your doctor about your options and make sure he/she has your complete medical history from your previous C-section. You can also choose to take birthing classes with your significant other so that you are both prepared for what is to come.
Choose your hospital well	Choose a well-equipped hospital that comes with constant fetal monitoring, a reliable staff that can perform an emergency C-section and anesthesiologists on call 24/7. Around the clock blood transfusion is also an important service to factor in.
Allow labor to begin naturally	Artificially inducing labor can cause the cervix to be closed too tightly, meaning that it is unprepared for childbirth. This increases the chances of having a uterine rupture.
Prepare for all possibilities	Complications such as preeclampsia, an issue with the placenta or umbilical cord, your baby being in the wrong position, your baby failing to cope with labor or even your labor failing to progress naturally, might occur. This will result in an emergency C-section so be prepared for the worst.