Vaginal birth after cesarean delivery (VBAC) is possible for many women, but it depends on many factors. Insisting on VBAC may put both you and your baby at risk; hence, you need to discuss the pros and cons with your doctor.
The following factors play an important role:
- Type of the previous incision used for cesarean delivery: Most cesarean deliveries nowadays are performed with a low transverse incision (the surgery cut along the bikini line). If you have had a prior high vertical-incision cesarean delivery (the cut runs from below your navel to your pubes), then normal vaginal delivery isn't possible.
- Previous uterine rupture: If you have uterine rupture (a tear in the womb muscle) in the past, then normal vaginal delivery is impossible.
- Previous other surgeries on your uterus: If you have had other surgeries in your womb, such as for fibroid removal, then normal vaginal birth is not recommended due to the risk of uterine (womb) rupture.
- No history of vaginal delivery: If you never had a vaginal delivery before or after your prior cesarean delivery, then it lowers your chances of having a vaginal normal delivery.
- Multiple previous cesarean deliveries: Your doctor will not offer a normal vaginal delivery option for you if you have had more than two prior cesarean deliveries.
- Duration since your last cesarean delivery: The risk of uterine (womb) rupture is higher if you attempt a normal vaginal delivery 18 months before your previous cesarean delivery.
- Any other health concerns that may affect a vaginal delivery attempt: A normal vaginal delivery after cesarean delivery is not possible if
- You have placental problems.
- Your baby is in an abnormal position.
- You are carrying twin, triplets, or multiples.
- You are pregnant beyond 40 weeks of gestation.
- Your baby has low birth weight or excess birth weight.
- Induction of labor: Having labor induced reduces the possibility of a normal vaginal delivery.
- Mother’s pre-existing diseases: A mother’s pre-existing medical diseases such as hypertension, obesity, diabetes, asthma, renal disease, and heart disease may lower the chances of successful VBAC.
VBAC is not always safe for every woman. Your doctor will decide if vaginal delivery is right for you and will discuss the risks and benefits of VBAC in your case.
What do VBAC and ERCS mean?
The term vaginal birth after cesarean delivery (VBAC) is used when a woman gives birth vaginally and has had a cesarean delivery in the past. A vaginal birth may include normal delivery and assisted birth by forceps or a vacuum cup.
ERCS means elective (planned) repeat cesarean section. You will usually have a planned cesarean delivery after 39 weeks of pregnancy because babies born by cesarean delivery earlier than this may have breathing problems.
If you are fit and healthy and tick off the appropriate boxes, both VBAC and ERCS are safe choices for you with very little risk.
What are the benefits of VBAC?
Benefits include:
- No surgical complications
- A shorter hospital stay
- Quicker recovery
- Quicker return to normal activities
- Higher chances of vaginal birth in future pregnancies
- No multiple risks of cesarean deliveries such as placental problems
- To be able to breastfeed your child successfully
What are the risks of VBAC?
Although vaginal birth after cesarean delivery (VBAC) does come with risks, many women are able to have one with no complications at all. A failed trial of labor in a woman who had a previous cesarean delivery is associated with possible serious complications.
Complications in the mother are as follows:
- Pelvic floor disorders
- Uterine rupture (rare, <1%)
- Burst opening of the cesarean scar
- May require a hysterectomy (surgical removal of the uterus) and then you will never be able to get pregnant
- Death
Complications in the baby are as follows:
- An increased heart rate of the baby during vaginal delivery
- Sepsis
- Trauma
- Brain damage
- Death of a baby in the womb
- Stillbirth (death of a baby after birth)
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National partnership for women and families http://www.childbirthconnection.org/giving-birth/vbac/research-evidence/research-and-evidence-q-a/c-section-problems.html
American College of Obstetricians and Gynecologists. Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstetrics & Gynecology. 2019; doi:10.1097/AOG.0000000000003078.
Mayoclinic https://www.mayoclinic.org/tests-procedures/vbac/about/pac-20395249
Royal College of Obstetricians & Gynaecologists https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-birth-options-after-previous-caesarean-section.pdf
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