VBAC stands for a vaginal birth after cesarean. If a woman has delivered a baby by Cesarean delivery and she is pregnant again, she may be able to choose between delivering through a repeat Cesarean delivery or vaginal birth after cesarean (VBAC).
VBAC may be attempted if the previous Cesarean delivery was performed at least more than 18 months prior to the current pregnancy. VBAC may not be possible for all women. VBAC may be contraindicated due to certain factors, such as uterine scarring or complicated delivery during the previous Cesarean delivery. If a trial of labor/VBAC fails or complications like uterine rupture occur, the doctor may perform an emergency Cesarean delivery to deliver the baby. Some hospitals may have the resources to perform VBAC or perform emergency Cesarean delivery, hence it is important to have a discussion with the doctor regarding the same and understand the pros, cons, and risks.
Why is VBAC done?
Some common reasons for choosing VBAC include:
- Positive effects on future pregnancies: If the woman is planning to have more children in the future, VBAC can help reduce the risks of multiple Cesarean deliveries in the future.
- Lower risk of surgical complications: Successful VBAC is associated with a lower risk of complications, such as excessive bleeding, infection, or formation of blood clots in one or more deep veins in the body (deep vein thrombosis). These blood clots in the veins can travel to the lungs, heart, or brain, causing fatal complications. VBAC may also decrease the risk of surgical removal of the uterus (hysterectomy), injury to surrounding abdominal organs, like the bladder or bowel, muscles, nerves, and other tissues.
- Shorter recovery time: The hospital stay following VBAC is shorter than a repeat Cesarean delivery. The recovery time is shorter compared to a Cesarean delivery and women can resume their normal activities sooner.
- Individual personal choice: Some women may want to experience a vaginal delivery.
Who is VBAC ideal for?
A woman may be a candidate for VBAC if
- She is pregnant with one baby, has a history of Cesarean delivery with low transverse (horizontal) incision without complications, and has no other contraindications to VBAC.
- She is pregnant with one baby, has a history of Cesarean delivery with an unknown uterine incision, and has no other contraindications to VBAC, unless it's suspected that she had a high vertical (classical) uterine incision in the previous Cesarean delivery.
- She is pregnant with twins or triplets, has a history of low transverse Cesarean delivery, and a candidate for twin or triplet vaginal delivery.
When is VBAC not done?
VBAC may be contraindicated in the following cases:
- A history of a high vertical (classical) uterine incision during the previous Cesarean delivery
- A history of Cesarean delivery with an unknown type of prior uterine incision or suspected classical incision
- A history of uterine rupture due to scarring from previous uttering surgeries
- A history of certain uterine surgeries, such as fibroid removal
- A history of more than two previous Cesarean deliveries
- Having a body mass index (BMI) of 40 or higher at the time of delivery and never had a single vaginal delivery in previous pregnancies
- A labor that is not progressing
- An advanced maternal age
- A pregnancy that continues longer than 40 weeks
- Preeclampsia (a dangerous complication of pregnancy due to high blood pressure)
- Previous Cesarean delivery within 18 months
- A closed cervix requiring labor induction
What are the complications of VBAC?
A successful VBAC is associated with a lesser risk of complications compared to an elective repeat Cesarean delivery. If a trial of labor/VBAC fails or complications like uterine rupture occur, the doctor may perform an emergency Cesarean delivery to deliver the baby. Uterine rupture is a life-threatening complication to the mother and baby. In the case of uterine rupture, hysterectomy (surgical removal of the uterus) may be required. Following a hysterectomy, a woman would not be able to get pregnant again. Other complications following VBAC include blood clots in the blood vessels, extensive bleeding, infection, and fetal distress.
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