What is a VBAC?
VBAC stands for vaginal birth after caesarean, which is exactly what it sounds like: a mother’s attempt at a vaginal delivery after surgical intervention in a previous childbirth experience. While it’s becoming more common, it is still a controversial procedure. Not all care providers are willing to work with an expectant mom who is interested in trying for a VBAC, so if your hope is to go this route, be sure to talk to your health professional early on about your wishes. If she isn’t supportive, you may be able to switch providers—but finding one who is open to your wishes, accepts your insurance policy, and has privileges at a hospital that allows for VBAC attempts might be a challenge. (In fact, depending on where you live, it might not be possible at all.) A VBAC could be worth fighting for, though. A surgical delivery always includes risks, such as excessive bleeding and the development of certain infections, which increase with each procedure. Recovery following a C-section is also longer and more difficult.
Is a VBAC always a good option?
According to Roger Harms, MD, OB/GYN at Mayo Clinic and medical editor in chief of MayoClinic.com, “VBACs are highly successful overall and should be encouraged if the patient’s risk of failure is not too high. We have had very good experience with VBACs.” They might not be an option for every mom, however. Women who are giving birth at an advanced age, are considered obese, or who have had a baby within the last 18 months might not be recommended for a VBAC. Certain factors specific to your pregnancy could weigh in too, even up until the day of delivery. Situations such as breech presentation, placenta previa, high infant birth weight, and pregnancies lasting beyond 42 weeks might make a VBAC a no-go.
As with any delivery, keep in mind that the desired end result is a healthy baby and mom, and in some cases, that means a C-section. A trusted team of medical professionals can help you make the right decision.
Who is a candidate for a VBAC?
Even considering the factors listed above, most women who have delivered a child via C-section are able to try to deliver vaginally for later births if they so choose. There is one caveat: “The woman needs to have had a transverse incision in her uterus for the previous C-section,” notes Harms. “After that, most patients are candidates with varying degrees of chances for success.” Before you and your doctor agree to try for a VBAC, there are a few things you’ll need to take into consideration.
- Why did you deliver via C-section previously? Women who have unsuccessfully tried to deliver vaginally in the past might have a harder time with a VBAC, since the factors that made their first delivery difficult (such as extremely narrow hips, obesity, etc.) might still be in play for subsequent deliveries.
- Have you ever delivered a child vaginally? It could be that you’ve given birth vaginally in the past, but your last delivery was done via C-section due to baby’s positioning or another situational factor. If so, your odds of successfully delivering vaginally again are very good.
- Have you ever had other extensive uterine surgery? If you’ve had a myomectomy to remove fibroids—or ever suffered from a uterine rupture—you will not be a candidate for VBAC.
Once it’s been confirmed that you are a good contender for a vaginal birth, you and your doctor will most likely agree to what is commonly referred to as a “trial of labor.” This means that you plan to go into labor naturally and will attempt to deliver vaginally, but your doctor will monitor you closely and a C-section will be performed if deemed necessary. If you’re thinking that sounds like the routine for any labor and delivery, you’re right. No matter how unwanted, a C-section is always a possibility if mom or baby’s health comes into question.
What are the risks?
“The most significant risk [during a VBAC] is rupture of the uterus at the site of the old scar,” Harms says. While it is rare (estimated at less than 1 percent), such rupture is “potentially very dangerous. This is by far the greatest risk,” explains Harms. Because of this risk, VBAC attempts are typically only offered at hospitals with access to rapid emergency C-sections should the need arise. Most doctors are also not comfortable with a VBAC delivery if labor is encouraged with medicine (i.e., an induction) rather than occurring naturally.
“The second most common issue is that the labor will fail to progress and a C-section will [still] be needed,” shares Harms. No one wants to labor for hours only to end up on an operating table, and it can be even more upsetting to a mom-to-be who was determined to go natural. Additionally, if you have a trial of labor and end up on the operating table anyway, you have a slightly higher risk of infection or surgical complication than if you had gone straight for a C-section.
What happens once you’ve decided to try for a VBAC?
Once you’ve worked out the logistics with your medical team, a VBAC isn’t approached much differently than a regular labor day. Harms notes, “VBAC patients should report to the hospital promptly when labor begins, and generally avoid inductions of labor.” When you arrive at the hospital, you’ll need continuous electronic fetal monitoring (a change in baby’s heartbeat could be the first sign of trouble) and an IV. You’ll also be asked to refrain from eating, in case the need for an emergency C-section does arise.
As with any pregnancy-related decision, it’s important to do your research, find a physician you trust, and make the choices you feel are best for you and your family. For some moms, a VBAC might be a no-brainer; for others, the decision may be less clear. Whatever the case, create a birth plan that allows for flexibility, and keep your eye on the prize: that beautiful wee one who will be placed in your arms at the finish line, regardless of how he gets here.