What You Need To Know
What Is It?
Vaginal birth after cesarean, or VBAC, refers to a vaginal birth after one or more cesareans. More than 80 percent of women who have had a cesarean can have a subsequent vaginal birth. The American College of Obstetricians and Gynecologists (ACOG) advises physicians to encourage women to plan on going through labor rather than scheduling a repeat surgery as long the women meet the following criteria: the previous cesarean must have involved a low transverse incision on both the abdomen and uterus (as opposed to a vertical incision) and the patient must be willing to prepare for a vaginal birth. Success rates for VBAC range from 60 to 80 percent.
Actually, only the uterus needs to have a low transverse incision, the skin incision is irrelevant. That is why if a woman has a vertical skin incision, she should inquire further as she may have a lower transverse incision on her uterus and can then plan for a VBAC is she so chooses.
Should I Have One?
There are many reasons to have a vaginal birth, both medical and emotional. For the mother, a vaginal birth reduces complications, including infection, blood loss, bowel injury and blood clots in the legs; recovery and breast-feeding are generally easier after a vaginal birth; and the cost of a vaginal birth is about $3,000 less than that of a cesarean. For the baby, VBAC reduces the chances of iatrogenic prematurity (when surgery is performed because of an error in determining the due date), persistent pulmonary hypertension and surgery-related fetal injuries such as lacerations and broken bones. VBAC also results in fewer fetal deaths than elective repeat cesareans.
VBAC results in fewer maternal and fetal deaths. It is actually the mothers who are at a higher risk of death with a repeat cesarean birth due to the risks of major abdominal surgery and anesthesia (both general and epidural) complications.
What Are Possible Complications?
Many women who have had a previous cesarean fear that their uterus will rupture during delivery. This concern dates back to when incisions during a cesarean were made vertically, as opposed to the low transverse incisions that are done today.
There are two types of uterine rupture: complete and incomplete. A complete uterine rupture is very unlikely today for several reasons: certain obstetrical practices, such as using high forceps, are no longer done; the amount of Pitocin, which is used to induce or stimulate labor, is regulated, as opposed to flowing freely via an IV; and incisions are no longer vertical. A complete uterine rupture occurs in less than 1 percent of women attempting VBAC. Incomplete uterine rupture, which occurs about 1 to 2 percent of the time, is usually asymptomatic and rarely leads to fetal or maternal death.
What You Can Do
Educate Yourself - To learn more about VBAC, turn to:
Once you decide on a VBAC, you can consider other birthing options, such as using a midwife, delivering at a birthing center or having a home birth. You should discuss these alternatives with your primary physician to be certain that someone is available to detect potential problems.
Medication is fairly controversial, even without VBAC. Pain relief medication can be used but should be administered wisely. Epidurals, for example, can increase the cesarean rate. You may want to consider delaying medications and using non-pharmacological methods of pain relief as long as you possibly can.
Consider having a doula present at your birth. Having a birth or labor doula support has been documented to half the cesarean rate.
There are many things you should do to prepare for a VBAC, mentally, physically and emotionally. First, get as much information as you can. Obtain a copy of your medical records from the previous birth(s). Read books and journals. Remember also to eat well and exercise. Being in good physical shape can help your labor move more quickly as well as speed healing. And, most importantly, talk to people: your care provider, your family, those who've had VBAC and those who haven't. Consider going to a support group. Emotions run high during pregnancy and it's important to discuss them.
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