Labor & Delivery

What You Need to Know About Having a VBAC

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The first time I heard the term “VBAC,” I was at the pool with a group of friends, all of whom had children already. Babies weren’t even on my radar, but I perked up when my friend told the group how badly she wanted to “try for a VBAC.” 

Too embarrassed to ask what it was, I called my Mom the next day and asked her. “It means vaginal birth after cesarean,” she told me. “And I had five of them.”

My oldest sister was born via C-section at 36 weeks because of a prolapsed umbilical cord. My mom went on to have five (yes, five) VBAC deliveries. While her case may not be the norm, a VBAC can be a possibility for you after a C-section. But there are factors that you and your doctor should consider before making a VBAC a part of your birth plan.

Here are eight things you might not know about having a VBAC.

 

1. The odds are in your favor

Board-certified OBGYN, Heather Rupe says that while C-sections are on the rise, (32 percent), 70 percent of women who try for a VBAC will be successful. Since a vaginal birth is not a major surgery like a C-section, it generally means a better recovery for the mom and a lower complication rate for the mom and baby. Some doctors might be hesitant to try for a VBAC for multiple reasons, but statistics show that it works for the majority of women (as long as your doctor gives the go-ahead.)

 

2. Higher risk pregnancies are not great VBAC candidates

Both you and baby should be in good health before your doctor will agree to a VBAC.

Risk factors for you and baby may include:

  • Obesity (your body mass index is 30 or higher)
  • High blood pressure during pregnancy, also known as pre-eclampsia
  • Age – usually if you’re older than 35 your doctor will say no, though that is not always the case (my mom had her last at 40!)
  • Your last cesarean was in the previous 19 months
  • The baby is measuring large

While these risk factors may not automatically exclude you from a VBAC, your doctor will use them to assess the safety of that route. 

 

Source: @b1withmoms

 

3. Complications with a VBAC are rare but severe 

During a C-section, a cut is made in the uterus to pull the baby out. The doctor will then sew the uterus back together. But the uterus remains damaged by the process and will be weaker than it was pre-cesarean. 

During a VBAC, the pressure of contractions in active labor can cause the old uterine scar to break open. While this only occurs 1 percent of the time, if it does happen, the mother risks hemorrhage and loss of her uterus. This emergency hysterectomy means the mother will not be able to get pregnant again. In some cases, oxygen can be cut off to the baby which can lead to brain damage or worse.

Given your C-section history, your doctor will be able to deduce the level of risk particular to your personal experience and body.

 

4. Home birth is not always an ideal option

While many women may desire a much different birth experience than they had with their C-section, a VBAC poses new risks to the baby and mother. A home birth is not always a safe choice because of the risk of uterine rupture. Sometimes, if you live in a rural area, your doctor may suggest traveling to a more urban hospital for a safe VBAC. 

The most recommended route is to deliver in a hospital with an obstetrician or midwife with access to an open operating room available in case you need surgery. You’ll also want a full medical staff present for your newborn if needed.

 

5. Your existing C-section incision is a factor

Does your scar run from top to bottom? Or from side to side? If your C-section incision is top to bottom, it is considered a vertical cut, and you cannot typically attempt a VBAC. There is a very high risk of uterine rupture with vertical scars.

But if your C-section scar runs side to side (transverse) and is low, you may be a candidate for a VBAC as long as other risk factors are low.

 

6. How many kids do you plan to have?

While this question may seem like no one’s business, repeated C-sections can cause serious complications. So if you plan to have more than three children, your doctor might encourage you to consider a VBAC. You should always talk to your doctor about your family plans so they can provide the best care and advice for your body.

In addition, the complications related to a fourth C-section are higher than a third, and a fifth is extremely risky. And if you’ve had four C-sections and are planning another pregnancy, you are at a 10 percent risk of developing accrete, where the placenta grows into the uterus. If this occurs, the usual outcome is a preterm delivery and a hysterectomy.

 

 

7. Your prior delivery history matters

If you’ve had other vaginal deliveries before you had a C-section, your odds of a successful VBAC are higher (around 90 percent). There is still a risk of rupture however, even if you have had other vaginal births, but it’s usually a smaller risk.

Likewise, the number of C-sections you’ve had matters. If you’ve had more than two C-sections, your doctor might not agree to a VBAC, since with each pregnancy, the complications and risks increase. And your timeline matters too. If you attempt a VBAC less than 18 months after having a C-section, your risks are higher for uterine rupture. and your doctor will likely not agree to try one.

 

8. The reasons for your previous C-section also matter 

Why did you have your previous C-section? If it was incidental (very large baby, breech, etc.) and this baby is a typical size and head down, for example, you may be a great candidate. 

If, however, you have continuing factors, such as placental problems, your reasons for needing a C-section could reoccur. And if your baby is in an abnormal position, or you’re carrying triplets or you have other risk factors, it’s likely a no-go.

A birth experience can be transformative for both mother and baby, and some women, even with a prior C-section, are able to successfully have a VBAC. But keep in mind that the end goal should always be for both you and baby to be safe and healthy. 

Your doctor is always the best person for you to talk through birthing options with. Being diligent about your own medical care is always recommended, as every woman, every body, and every baby is vastly different.

If a VBAC is not right for you, remember that there are benefits to a C-section too. Talk to your doctor, create a birth plan, and recognize that the odds are already in your favor, regardless of what your delivery looks like.

Because in the end, whether VBAC or C-section, you have will have a beautiful baby. And the means of getting them into your arms is secondary.