Vaginal Birth After Cesarean

If you've already had a baby by cesarean section, it doesn't rule out the possibility of vaginal birth for your next delivery. Many women deliver a baby vaginally after a previous cesarean without incident. But along with the benefits of vaginal birth after cesarean (VBAC), there are risks you need to be aware of. Read these important facts, and discuss your concerns and wishes with your obstetrician.

Who can have a VBAC?

According to the American College of Obstetricians and Gynecologists (ACOG), of the women who attempt VBAC about 60 to 80 percent are successful. The remaining women end up having another cesarean. If you're healthy, and have no pregnancy risk factors, then VBAC may be a possibility your obstetrician can help you evaluate.

What are the benefits?

There are several reasons why you might want to try VBAC. Some women simply want to try the experience of vaginal birth. There are also medical reasons why VBAC appeals to women and their health-care providers instead of a repeat cesarean:

• Elimination of the need for abdominal surgery, which has inherent risks (infection, hemorrhage, and anesthesia-related complications, for instance)
• Reduction of the risk for possible blood transfusions, thus decreasing risk of blood-borne disease
• Decreased length of hospital stay
• Shorter time needed for recovery

What are the risks of VBAC?

The primary risk factor for VBAC is the possibility of uterine rupture. Uterine rupture can be life-threatening for mother and baby. The likelihood of uterine rupture is rare, but because it's a serious situation, your risk must be carefully evaluated by your health-care provider. A development in a July 2001 study by researchers at the University of Washington in Seattle published in the New England Journal of Medicine indicates that there's an increased risk of uterine rupture with VBAC, especially if you need to be induced. The risk varies depending upon previous deliveries, length of labor, and other factors your health-care provider will determine upon evaluating you as a possible candidate for VBAC.

Also, according to the ACOG there's a greater risk of infection for mother and baby in cases of attempted VBAC followed by cesarean. Nevertheless, if you're going to have a VBAC, you should give birth in a facility that's equipped to do emergency cesareans, should the need for one arise.

Is VBAC right for me?

There are several considerations for determining who is a good candidate for VBAC. Your doctor will review these factors and will tell you if any of these factors make VBAC too risky to consider:

• Type of incision: If you had a high vertical or "classical" cesarean, made by cutting vertically in the upper uterus, your risk of uterine rupture is greater than if you had a lower horizontal or vertical cut along the lower (and thinner) portion of the uterus. Your doctor can tell which type of cesarean you've previously had from your medical records.
• Number of previous cesareans: The risk of uterine rupture increases with each cesarean performed. The risk of rupture is greatest along previous cesarean scars.
• Length of time since your cesarean: Ideally, a minimum of nine months will have elapsed before you conceive again. The more time your body has to recover after the surgery, the stronger it will be for the next birth.
• Size of baby: Another important consideration is the size of the baby relative to the size of your pelvis. If the baby can't fit, your uterus may be subject to prolonged stress in a delivery that won't progress properly. Your doctor can evaluate the size of the baby relative to your pelvis through ultrasound.
• Problems for the baby: There may be factors that could signal possible complications during the baby's delivery (for example, breech presentation), which, coupled with the other risk factors of prior cesarean, might make VBAC too risky.
• Placental problems: If you have placenta previa (low-lying placenta) or abruptio placenta (placental separation from the womb), it may be too risky to proceed with VBAC.
• Health conditions: If there are serious medical or obstetric conditions at the time of your baby's birth, your health-care provider may caution against VBAC.

Ultimately, most of these factors can be identified prior to the delivery. So you should be able to discuss your options and wishes at length with your health-care provider.

Should I have a VBAC?

This is something only you and your doctor can decide. You must carefully weigh the risks against the benefits with the guidance of a qualified health-care provider. Discuss your concerns and feelings with your provider and make your most informed decision about VBAC.

Source: The American College of Obstetricians and Gynecologists

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.