Risks and Benefits of Vaginal Birth After C-Section – Who Should Try VBAC?

Risks and Benefits of Vaginal Birth After C-Section – Who Should Try VBAC?

For many years and still today in many regions across the world, there is a belief that the safest choice of delivering after the first baby is another cesarean. But many organizations and medical bodies no longer consider this to be the only option. If vaginal delivery is possible after c-section or not, we will discuss in this story.

What is Vaginal Birth After C-Section (VBAC)?

VBAC is an option of choosing the normal vaginal birth after delivering the baby with cesarean earlier. If you have had a history of c-section delivery, the next time you become pregnant you can choose Vaginal Birth After C-Section if you want to deliver your baby normally.

Before attempting the vaginal delivery after c-section, generally women have to go through trial of labor cesarean (TOLAC). This is a planned attempt to labor and if it is successful, then they can go with the VBAC option.

What is the success rate of VBAC?

According to American Congress of Obstetricians and Gynecologists (ACOG), VBAC can be a safe and an appropriate option for many women. It can even work for women who have given birth via c-section twice before. In fact study on women who attempted TOLAC before VBAC shows that 60-80 percent were successful in delivering vaginally.

Many countries including India have high rates of cesarean delivery. In fact, in many regions it is more common than vaginal birth. According to WHO, the ideal rates for cesarean is between 10-15 percent, after that the national rates of maternal and infant mortality will begin to rise.

Benefits of VBAC

VBAC has its own benefits and risks, the doctor is the best person to determine the best plan for both mother and the baby. Here are some of the benefits of this technique:

Faster recovery

A woman who undergoes VBAC would typically have a short stay in the hospital. This will not only help her resume normal activities soon but also reduce hospital expenses.

A sense of involvement in the birthing process

Many women chooses VBAC just to become active participant and experience the labor and delivery process.

Outcomes on future pregnancies

For women, who desire for building larger families, VBAC can be a good option as it may help her avoid the risks of multiple c-section deliveries such as scarring. If there is a need of additional surgery, scarring can create troubles and there could be high chances of placental problems such as placenta previa and placenta abruption in future pregnancies.

Lesser risk of complications

There are fewer risks in vaginal delivery which can be due to infection, blood loss, blood clotting or any other injury to abdominal organs.

Are there any risks of VBAC?

Normally, VBAC is associated with lesser complications as compared to elective repeat C-section. The riskiest case could be when vaginal delivery fails and there is a need to deliver the child through emergency c-section. A VBAC may also fail due to rupture in the uterus, but it occurs rarely. But in case it happens, there is an urgent need of cesarean delivery to avoid life threatening complications such as infection and heavy bleeding in mother and brain damage in the baby.

If the uterine rupture is complex, the doctor may also suggest complete removal of the uterus or hysterectomy, following which a woman cannot get pregnant again. However, as per American College of Obstetricians and Gynecologists (ACOG), women who had previous c-section with low transverse horizontal incisions, have lesser (1 in 500) chances of uterine rupture.

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Who is the best candidate for VBAC?

The doctors generally take following factors in mind while suggesting VBAC to women:

  • Women who delivered vaginally in previous pregnancy
  • Women under 40 years of age
  • The baby is in head down position
  • The baby should not be large, less than 3.2 kgs of weight have good chances
  • The previous issues or complications are not there in current pregnancy
  • Women who had low transverse or horizontal incision in previous cesarean delivery
  • When start of the labor is spontaneous, if it is induced there will be stronger and faster contractions which can lead to uterine rupture

Who should not try VBAC?

There are situations when VBAC might not be the ideal option for a woman. These include:

  • History of classical or high vertical incision
  • Due date has passed
  • Prior uterine rupture
  • Certain surgeries such as removal of fibroid

How can a woman prepare for VBAC

This is one of the important topics you need to discuss with your doctor well in advance. The doctor would review your medical history and tally it with your current pregnancy status.

  1. You can research for a doctor or expert who is both supportive and have known for performing less cesarean deliveries.
  2. You can also search for a childbirth class that covers the topic of VBAC. Make sure you take along your husband or partner too.
  3. Make sure the hospital you choose is well equipped as VBAC needs careful monitoring of you and your baby. If there is an emergency, the hospital should be capable of handling the surgical process.
  4. If possible, you should wait for the labor to start on its own. And remember, the medicines which are used to induce labor might bring stronger and faster contractions which can increase the chance of uterine rupture.
  5. You don’t have to do any special preparations for VBAC during your pregnancy. However, you have to take care of yourself just like your previous pregnancies.
  6. The delivery process will be normal but expect there will be close monitoring during the labor and delivery.

Outlook

Vaginal birth after c-section is a good choice to make. It has its own benefits and risks, but the former have an upper hand. VBAC has promising rate of success but you have to be well-prepared for complications that would require further surgeries. Your labor can stop progress, the position of the baby can pose a risk or other problems related to placenta and umbilical cord.

So, talk to your doctor and review your decision of choosing this procedure. But remember, the health of the mother and the baby should be the ultimate aim no matter if you have to undergo c-section again. But that too is perfectly normal and experience of having a healthy baby should give you joy and relief.

Sources

1. Vaginal birth after c-section. read more
2. The basics of VBAC. read more
3. Hospital Stay for Healthy Term Newborn Infants. Pediatrics. May 2015, Volume 135, Issue 5.  
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