Vaginal Birth After Cesarean Delivery (VBAC)
If you’re due to deliver soon and have had a C-section before, some comforting statistics should make you feel better about a vaginal birth after cesarean (VBAC).
Generally, vaginal births are safer than multiple C-sections. Vaginal birth after cesarean delivery (VBAC), poses risks for both mother and child.
Giving birth the traditional way without surgical intervention may be something you have always wanted. However if for some reasons medical emergency comes in necessitating C-section, it may affect future pregnancies. According to the Centers for Disease Control and Prevention (CDC), nearly a third of all births in the United States are thru C-sections, making this a matter of concern for a lot of women as they plan their next baby.
While risks of uterine rupture exist, the chances aren’t worse than when having multiple C-sections. What’s best depends on your health, age, and pregnancy complications if any.
VBAC May Pose Risks For Both Baby And Mother
What you need to start with is an awareness that a VBAC is not without its own risks. Here’s a look at some of them.
Risk of Uterine Rupture
One of the biggest risks around VBAC is the possibility of having a uterine rupture. This may happen if your old cesarean scar on the uterus breaks open due to the effort of labor and the strain of a vaginal delivery. This can be deadly to you and your baby if it happens and is best avoided if you are considered at high risk of rupture.
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Your doctor or an experienced midwife can monitor the progress of delivery to check for abnormalities like pain between contractions, bleeding, or changes to your heartbeat or your baby’s that can warn of a possible complication or rupture during VBAC. They will switch to a cesarean if they suspect a possible rupture.
Increased Risk of Bleeding And Infection From Emergency Cesarean Section
If your VBAC goes wrong halfway, your doctor may need to perform an emergency cesarean section. Unfortunately, this is associated with greater risk of bleeding and your contracting an infection from the procedure.
Slightly higher mortality risk to the baby
Fetal mortality rates as well as perinatal and neonatal (before and after birth) mortality rates are lower in women who go for elective repeat cesarean section delivery than in those who choose to attempt a VBAC and go through labor as with a normal vaginal birth (trial of labor). But maternal risk is lower for trial of labor, the precursor to VBAC, than for elective repeat cesarean delivery.
Obesity, preeclampsia, and other factors make VBAC risky
If you are someone with earlier cases of uterine rupture, diabetes, heart disease, someone who has had uterine surgery, or have pregnancy complication, a cesarean section may be your only option, so go with what your doctor suggests or get a second doctor’s opinion. Your risk of VBAC may be high if:
- You are obese
- You have had more than 2 low transverse c-section deliveries or you’ve had a rupture or other problems in a previous delivery
- Your labor has to be induced/you are past your due date.
- You have preeclampsia, a condition that results in high blood pressure, vision problems, headaches, protein in the urine, and problems with your liver/kidney.
- The gap between your last pregnancy and this one (interpregnancy interval) is less than 19 months.
- Your birth location isn’t equipped to do an emergency cesarean section should you need one midway through a VBAC attempt.
VBAC is less risky than multiple C-sections
If you have two or more previous low transverse incision cesarean deliveries, you may still be able to go for VBAC if a senior obstetrician gives you the go ahead. All the possible risks will be discussed with you and the necessary arrangements will be made for added safety during the birth.
If you are considering having repeat cesarean deliveries to reduce the risk of a ruptured uterus or other complications, this may be risky. According to a report by the CDC, women undergoing repeat cesarean deliveries actually have the highest rates of ruptured uterus as well as of unintended hysterectomies, while those who chose VBAC deliveries have lower rate of maternal sicknesses.
Most women with earlier C-Sections are eligible for vaginal births
You don’t have to worry that a previous cesarean section inevitably eliminates you from the option of a vaginal birth and labor the traditional way. This is because as many as 90% of women who have delivered an earlier baby through cesarean section are possible candidates for VBAC. Of those who are cleared to opt for the labor and vaginal delivery route, 60 to 80% on average are able to successfully give birth this way.
Advantages of vaginal delivery over multiple Cesarean Sections
There are reasons why women choose vaginal deliveries. According to some studies, the success of rate of VBAC in twin pregnancies was similar to those singleton pregnancies. Though other conditions affecting the risk or possibility of success like maternal age and health, still apply. Some of the advantages of vaginal deliveries include:
- Faster recovery
- No surgery involved
- Lower risk of infection
- Lower blood loss
Also, a VBAC reduces your risk from other complications that can arise for women with multiple cesarean sections in future pregnancies. Multiple cesarean sections are linked to:
- Greater risk of bowel/bladder injury
- Possible complications with the placenta in future pregnancies
- Greater risk of a need for hysterectomy
Factors that may improve your eligibility for VBAC
Remember, even if your mind is set on a VBAC, certain factors could help or deter your cause. Here are some things that could make you eligible for VBAC:
- If the reason you had the cesarean section in the previous pregnancy is not present now.
- If you do not have any additional uterine scars, any anomalies, or prior ruptures, you should be fine to have VBAC.
- If you are in otherwise good health.
- If your baby is normal sized.
- If the baby is in the right position, head down, for a vaginal delivery.
- If your cervix is dilated to 3 cm or more when you are admitted
- If you go into labor on your own before your due date.
- If your doctor and team monitor your progress through labor and to decide if you need a cesarean at some point.