Vaginal Birth After A C-Section (VBAC) as Delivery Option

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Women who had a delivery through C-section before, have an option to select going through a C-section or vaginal delivery after Cesarean (VBAC). About 60 to 80 percent of all women attempting TOLAC, the trial of labor after cesarean, go through successful vaginal delivery. However, not every woman can go for VBAC. There are certain factors that can make this option inappropriate like a high-risk uterine scar. The procedure is a bit complicated. That is why some hospitals don’t even offer VBAC as they are not equipped for handling emergency C-sections. So, before you decide on whether you want to go through VBAC or not, you need to discuss with your healthcare provider whether you are a viable candidate or not.

Now, the question is why would women want to consider VBAC. There are several reasons why VBAC is a viable option for second delivery.

VBAC for second delivery:

  1. It has a shorter recovery time

    A repeat C-section will result in a longer stay at the hospital than after a VBAC. Since you have avoided surgery, you will be able to get back to your daily routine sooner. Also, the expenses of childbirth will be reduced.

  2. It gives you an individualized birth plan

    Women who want to have an experience of vaginal delivery can go for VBAC.

  3. It helps with future pregnancies

    If you want to have a larger family, having multiple cesarean deliveries can lead to some risks like scarring. VBAC can help you avoid this. Also, scarring can lead to difficulties in additional surgeries. It also makes you vulnerable to placental problems during pregnancies.

  4. It has decreased the risk of surgical complications

    Vaginal deliveries have a lower risk of infection, bleeding, injury to abdominal organs like bowel or bladder, and blood clotting in the deep veins known as deep vein thrombosis.

Before you go for VBAC, you should make sure that you have no issues that might prevent VBAC. To help you learn whether you are a viable candidate VBAC, here is a checklist you can use:

VBAC checklist

You are pregnant with just one baby and have a history of at least one low transverse C-sections.
You are pregnant with just one baby and have had a previous C-section with the uterine incision. You must not have had a high vertical uterine incision.
You are pregnant with twins and have had one low transverse C-section.

For better understanding, here is a list of factors that makes your pregnancy inappropriate for VBAC:

  • A high-vertical uterine incision in the previous delivery
  • An unknown uterine incision that might be classical
  • Uterine rupture during past deliveries
  • Had gone through a uterine surgery like fibroid removal
  • Some hospitals don’t offer VBAC to women who had two C-sections before
  • It is not recommended for women who are pregnant with more than two babies

Even if you decided to go through VBAC when you got pregnant, certain factors can decrease the likelihood of this happening. This includes the following:

  • Advanced maternal age
  • Stalled labor
  • Pregnancy continuing past 40 weeks
  • Excessive weight gain
  • Preeclampsia
  • BMI greater than or equal to 40 that causes severe maternal obesity
  • Last delivery was within 18 months
  • Need for induced labor
  • History of no vaginal deliveries and more than 2 C-sections

Now, as discussed earlier, VBAC has fewer complications than a repeat C-section. However, if the Trial of Labor after Cesarean (TOLAc) fails, it can lead to even more complications like a uterine rupture. If during labor, the uterus gets torn open, an emergency C-section might be the only option for preventing life-threatening complications like heavy bleeding. It the rupture is too complicated and the bleeding can’t be stopped, a hysterectomy might be performed for removing the uterus. However, this will stop you from getting pregnant ever again.

Even after carefully considering the pros and cons of VBAC, you are still willing to go for it, you need to start talking to your healthcare provider regarding this in your first prenatal visit. All your concerns and expectations need to be discussed beforehand. After checking your medical history including details of previous uterine procedures or C-sections, he or she will decide what is best for you and your baby. The healthcare provider will calculate the likelihood of a successful VBAC.