Q&A: What Are the Risks and Benefits of VBAC?

Dr. Elizabeth Pryor answers the question, Should I have a VBAC?

Question

I had a c-section and have heard that I should wait at least 18 months between babies because I would like to try a VBAC (vaginal birth after cesarean). I am in good shape, and the doctor said that at 7 pounds, 15 ounces, the baby was a good size for me. He was just "sunny-side up" -- facing the ceiling instead of the floor. Does this indicate less of a chance for successful VBAC?

Answer

There is actually very little research that addresses this problem. There is a school of thought that women should wait one year before attempting VBAC in hopes of being assured that the scar in the womb is fully healed. There is little data to support this theory. There is also no data or research that supports a woman waiting 18 months, so I would be assured that your risks would be the same as those of a woman who had a c-section two years or more in the past.

One of the most serious risks is uterine rupture, where the scar in the womb separates in labor. Very rarely the separation can occur before labor. The risk is approximately 1 percent in women attempting VBAC. VBAC success is also related to why you had your c-section in the first place. If your first baby was head up (breech) and your second baby is head down, then you have an excellent chance for successful VBAC. On the other hand, if you pushed for 2 or 3 hours, and then the doctor had to perform a c-section, then your chances for a successful VBAC are slim. Additionally, a recent study showed that if a patient is obese, her chance for successful VBAC is only 13 percent.

Weigh the risks and benefits of VBAC versus c-section, and discuss this with your obstetrician. Then you can elect to attempt a VBAC, or have a repeat c-section -- depending on your desires. In patients attempting VBAC, we generally do not let them labor as long if there has been no progress. This fact is encouraging to many women who are motivated to attempt VBAC, but who do not want to endure a long labor similar to their previous one.

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.

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