What is a Vaginal Birth After Cesarean?
If you have had a baby with a C-section, there are two options for the delivery of your next baby. You can either schedule another C-section or attempt a vaginal birth after cesarean (VBAC).
If you feel strongly about having a vaginal birth after you’ve had a C-section, consider the benefits and risks as well as whether or not you are a candidate for this type of birth. Many women find the benefits of VBAC to outweigh the risks, and a doctor can evaluate you to make sure you meet the requirements for having the best chance of a successful vaginal delivery after a C-section.
Attempting a VBAC is referred to as a trial of labor after cesarean (TOLAC). Data indicates that between 60-80% of all trials of labor after cesarean and VBACs are successful.
Benefits
- No abdominal surgery is required when VBAC is successful. This cuts down on the risks associated with C-sections.
- Recovery time after vaginal birth is usually shorter and requires less bed rest than a cesarean. You will still need to heal, but you won’t have an abdominal incision to worry about and there will be fewer restrictions on walking around and lifting things.
- Individualized birth plans are possible with vaginal birth, rather than a C-section where surgery is planned. So, if you want to have the experience of labor and delivering your baby, VBAC can make that possible.
- Effect on future pregnancies: Having multiple C-sections will increase your chances of requiring scheduled cesarean for future pregnancies. If you plan on having a larger family and want to reduce your chances of needing another C-section, VBAC is a good option.
- Less blood loss is involved with vaginal birth (including VBAC) than with surgery.
Risks
The risks associated with a VBAC are generally less than the risks of a C-section, but only if the VBAC is successful. If your doctor is monitoring your delivery and feels there is a danger to you or the baby, a C-section may be necessary and then the risks associated with cesarean are of concern.
More serious complications come into play when the VBAC is attempted but fails. Failed Trial of Labor After Cesarean (TOLAC) complications include uterine rupture, which necessitates an emergency C-section and a possible hysterectomy if the rupture is severe.
Candidates for VBAC
To decide whether you are a good candidate for VBAC, your doctor will talk with you about your medical history, with a focus on the details of your previous C-section(s).
You might be a good candidate for VBAC if:
- You are only pregnant with one baby and have had 1 or 2 C-sections with low transverse incisions and have no problems that would prevent or complicate VBAC.
- You are pregnant with one baby and have had 1 C-section with an unknown type of incision that is not suspected to be a high vertical (classical) uterine incision and have no problems that would prevent or complicate VBAC
- You are pregnant with twins, have had 1 C-section with a low transverse uterine incision and meet other requirements for a twin vaginal delivery
Your doctor will probably rule out VBAC if you’ve had:
- A prior C-section with a high vertical (classical) uterine incision
- A previous uterine incision of unknown type that is suspected to be a high vertical incision
- Certain types of uterine surgeries, such as fibroid removal
- Prior uterine rupture
Other factors that may decrease your chance to have a successful VBAC include:
- A history of 2 or more C-sections and no vaginal births
- Advanced maternal age
- Excessive weight gain during pregnancy
- Maternal obesity (mother has a BMI of 40 or higher)
- Pregnancy that continues past 40 weeks
- Labor induction
- Stalled labor
- Previous delivery in the last 18 months
Where Can I Have a VBAC?
Because not all VBACs are successful, you should plan to give birth in a hospital facility equipped to handle an emergency C-section. During labor, doctors often recommend continuous fetal monitoring to detect distress and complications. If the doctor believes complications like a uterine rupture are possible, a repeat C-section will be recommended.
Make an Appointment
Not all doctors and hospitals offer VBAC, but the physicians at Raleigh OB/GYN will work with you if that is part of your ideal birth plan. We will make sure you meet the requirements to be a good candidate for a vaginal birth after cesarean and monitor you during labor to make sure things are going well and both you and baby are safe and healthy. And if necessary, we are qualified to handle a C-section if the TOLAC is not successful. To talk about possible birth plans like VBAC, call us at (919) 876-8225 or request an appointment online to discuss your options.
