VBAC Vaginal Birth after Cesarean. Is It Right for You?

Benefits:

There are some clear benefits to a VBAC birth.  For one, the recovery process is much less severe.  It is always more preferable to give birth without a surgical incision than a birth that requires one.  And as such, a hospital stay, and the return to normal every day condition are much quicker.  Also, the risk of other complications like postpartum fever, postpartum depression, difficulty breastfeeding, thromboembolism (blood clots in the leg or lung), and infection are lower with a VBAC birth.  But perhaps the most important benefit is that a VBAC birth can be very healing from past birth trauma.  Even if your birth ends in a cesarean, there are still many benefits to mom and baby by attempting a natural, vaginal delivery, and laboring freely.

Eligibility & Risks:

The first question that expectant mothers who have had a previous cesarean and wish to have a natural vaginal birth ask is: is it possible for me?  The answer to the question depends on a few things.

First, what are the circumstances that led to their first C-section?  If there were health related reasons, the default approach is to prepare for those same things to take place in subsequent pregnancies.  It goes without saying that a mother that had a normal, healthy pregnancy, with no complications is a much better candidate for a VBAC birth than a mother who had a complicated pregnancy, which may have been compounded by other health issues.

Second, what kind of C-section incision did the expectant mother who desires a VBAC birth have?  If the C-section involved a Low Transverse C Section, then there is a good, to great prospect of having a successful VBAC.

Low transverse C Section is when a single incision takes place on the lower section of the uterus.  If you have had one low transverse C Section, then you have a good risk profile and are a likely candidate for a VBAC.  That risk rises dramatically if you have had multiple low transverse C Sections.  Also, if you have had a classical uterine incision, or a T-incision, which usually takes place when a previous birth is premature, the risk level rises to a level that a VBAC may not be a possibility.  A mother with a previous uterine rupture is also not a good candidate for a VBAC.

The size of your baby can also play a role in the risk assessment of a mother who wishes to have a VBAC.  If the baby is of average size and weight, you stand to have a better chance of success than if your baby is above average.

Mothers who have had a C Section but have had a vaginal birth before are also much more likely to have a successful VBAC birth.

The primary concern with moving forward with a VBAC birth is the possibility of a uterine rupture, or the scar of a previous C Section failing.  The good news is that a uterine rupture is very rare, and happens to less than 1 percent of women who proceed with an attempt at Vaginal Birth after Cesarean; and this chance increases when labor is induced with Pitocin.

Prepare:

If you are considering a VBAC birth, a Certified Nurse Midwife can help answer your questions and concerns, and give you advice and detail expectations in your journey.  Some of the ways midwives prepare their clients who wish to have a VBAC are to help them release any emotions they may be harboring about a previous C Section.  Great childbirth education classes, and support groups are great resources for expectant mothers of any circumstance.  Hiring a Doula to support and attending your birth, will also greatly increase your chance of being successful.

And of course, eating healthy and exercising regularly are also efforts that should be made.  It is imperative that mothers who wish to have a VBAC keep their blood pressure within the normal spectrum, and avoid the possibility of gestational diabetes, edema, or preeclampsia.

Be sure to be in possession of your most up to date medical records so your Nurse Midwife can ensure you’re a low-risk candidate.  Having a solid birth plan is also essential.  Something your Doula, childbirth teacher and Midwife can assist you in creating.  But most importantly, trusting your health care provider can play a key role in having a successful VBAC birth.  It’s important to do your research and find someone who supports your choices, and goals.

Birth Location:

Now the next question women who are considering a VBAC might have, is where they should consider having their VBAC, or TOLAC (Trial of Labor after Cesarean)?  Finding a supportive care provider to assist you with a VBAC birth in a hospital can be a bit difficult in some areas.  And with the average chance of having a Cesarean birth in the hospital already being at 33%, that increases if you’ve had a previous cesarean birth.  Many first-time Caesarean Section births are the result of the “Cascade of Interventions”, which is very common in a hospital setting.  Know you have choices for where to attempt your VBAC birth, and be sure to explore all those options.

You might be surprised to know… most women who attempt a low-risk VBAC birth, are successful!  Especially when attended by a supportive care provider, in a supportive environment.