Everything You Need to Know About Vaginal Birth After Cesarean (VBAC)

It is your second time being pregnant and while you are excited for baby #2 to arrive, you may also be worrying that may go through pregnancy differently. This is especially true if first one was through a C-section due to certain conditions. But, you are now given the opportunity to deliver naturally. What do you do? Would you consider having a vaginal birth after cesarean? Or would you opt to do it again the same way?

This article shares all that you need to know before coming into the procedure.

There are some women who first delivered via C-section, but may want to have a normal delivery for their next ones. Back then, doctors did not recommend women who underwent the said procedure to have a vaginal birth on their subsequent pregnancies, However, vaginal birth after cesarean is now regarded as a safe option for mothers.

Understanding Vaginal Birth After Cesarean (VBAC)

Vaginal birth after cesarean (VBAC) refers to giving birth vaginally after having previously given birth via cesarean section (C-section).

A C-section is performed by making a surgical incision through your belly and then through your uterus for a variety of reasons. It is mostly in consideration of your safety, as well as your baby’s wellbeing.

Patients who opt for VBAC have to undergo a trial of labor (TOL) or a trial of labor after cesarean section (TOLAC). While TOL is a well-known safe procedure, some serious potential complications may arise including but not limited to:

• Uterine rupture (Dehiscence)
• Maternal and/or neonatal morbidity and mortality

If the rupture occurs, then you may be at risk of:

• Blood loss
• Blood clots
• Hysterectomy
• Bladder damage
• Other infections

Is It Safe to Have a Vaginal Birth after Cesarean?

As per the American Pregnancy Association, published studies show that 60% to 80% of women who had a cesarean birth had a successful vaginal birth delivery. Another statistic from the National Institute of Child Health and Human Development revealed that approximately 75% of vaginal birth after cesarean attempts are successful.

If you and your baby are in good health and your pregnancy is progressing normally, you have a better chance of having a successful VBAC.

Why Do Some Women Opt for Vaginal Birth after Cesarean? What Are Its Benefits?

Some women consider undergoing a trial of labor due to the following reasons:

• Shorter recovery time
• No need to undergo abdominal surgery
• Lower possibility of infection and other complications (i.e., excessive bleeding, blood clotting)
• Less scarring on the uterus
• Less pain after delivery

In addition to those, VBAC may help you avoid the risks associated with multiple cesarean deliveries, like placenta previa or placenta accreta. This is especially helpful if you intend to have multiple pregnancies in the future.

There are also other women who place great importance on being able to decide on their birth plan and have a normal delivery.

You are eligible to have a VBAC if you meet any of the following criteria:

• If you have had one previous C-section with known indication and incision.
• You should not have cephalopelvic disproportion (CPD).
• The previous C-section incision used is not classical.
• Present pregnancy is not bigger than the previous pregnancy.
• The interval of previous pregnancy should be more than 3 years. But some doctors may deem it safe after at least 12 months, granted there are certain risks.
• The present pregnancy must be in a cephalic position (or “head first”, not breech or “feet first”).

What Are the Risks of Having a Vaginal Birth after Cesarean?

As with any other delivery, there are some risks involving VBAC. The most serious complication that can happen to patients undergoing TOLAC is a uterine rupture. This refers to an incision made into the uterus during the previous cesarean delivery.

When the uterus ruptures, it disrupts the flow of blood and oxygen to the baby, which can lead to fetal complications such as:

• Fetal acidosis
• Need for neonatal intensive care unit (NICU) admission

There are some rare cases wherein it could also lead to the baby’s death. Moreover, there are also risks in the mother’s health like she may experience having a hemorrhage.

When a hemorrhage takes place in this situation, transfusion and, in some cases, hysterectomy are necessary to control the bleeding and can save her life.

Other risks and complications include:

• After contractions begin, labor does not progress.
• Tears in the vaginal and surrounding tissues occur during childbirth (called perineal tears).
• The baby is not getting enough oxygen (perinatal asphyxia).
• The baby’s shoulder becomes entangled in the vagina (shoulder dystocia).
• Problems with the umbilical cord.
• Excessive bleeding because of a placenta that remains in the uterus.

Key Takeaway

Make sure you discuss these matters with your obstetrician should you wish to have a vaginal birth after cesarean delivery.

At the end of the day, what matters most is to have a safe and healthy delivery for you and your baby.

Learn more about Labor and Delivery here.