Labor and Delivery: Is A VBAC Right For You?
If you've had a C-section with one or more of your past pregnancies, you may be wondering if a VBAC (vaginal birth after C-section) might be an option for you in the future. But what exactly is a VBAC and how do you know if it's right for you?
A VBAC is just as the name describes: when a woman has a vaginal birth after having a previous C-section or more than one C-section. In some cases, a VBAC might happen spontaneously, like when a woman simply goes into labor and delivers before a surgery can be arranged, but in many other cases, a woman chooses a VBAC on purpose.
Historically, women who had a C-section were required to have a C-section for any subsequent births after the C-section, period. It didn't matter what she wanted, it didn't matter if she was low-risk, and it didn't matter if she couldn't afford the C-section. Doctors believed that the risk of trying to have a vaginal delivery after a C-section was far too great because of the scar tissue from the C-section. If the scar tissue burst, both the woman and the baby could die very quickly.
Now, however, as C-section technology has advanced, the risk of a serious complication like a uterine rupture has drastically decreased and women's health organizations like the American College of Obstetricians & Gynecology support VBACs as a medically safe and advantageous form of delivery for women and babies alike.
Why would a woman choose a VBAC?
A woman might choose to have a VBAC for several reasons: she might simply want to experience having a vaginal birth, she may wish to have a different type of birth for both her and her baby, or she may want to avoid having surgery, along with all of the physical recovery that a C-section brings. A vaginal birth that does not have any complications is also a much more affordable option than a surgical birth.
The ACOG lists that there are actually many benefits to having a VBAC, which include:
Who is a candidate for a VBAC?
According to the 2017's ACOG VBAC guidelines, in general, women who have had one previous C-section with a low transverse incision (the most common kind of incision, when a small cut is made across the bottom of the uterus) are the primary candidates for a VBAC. However, women with other situations should consult with their doctor to determine if they are a candidate for a VBAC on a case-by-case basis.
What questions should you ask your care provider about having a VBAC?
Is your facility prepared for emergencies?
The main question, aside from finding out if the facility you plan to deliver at has a policy against VBACs (some may refuse to do them all together) is to ask if the facility is equipped to handle an emergency surgical delivery. The ACOG advises that VBACs only be offered in facilities that can accommodate an emergency delivery if something goes wrong. Although serious complications are rare with a VBAC, going through labor at a facility that you know can accommodate you should something go wrong is necessary peace of mind for both you and your little one.
How do you feel about VBACs?
It's also a good idea to straight-out ask your care provider how he/she feels about VBACs. If you have done your research, know that a VBAC could be an option for you and feel strongly about attempting it, but your care provider is not supportive, he/she may not be the best fit for you. You want someone who will be supportive of you, no matter what the outcome might be.
What kind of incision do I have?
If your care provider is the same provider who did your first C-section, it's important that you know what type of incision you had to help guide your decision. The most common type of incision, called a transverse, carries a low risk of uterine rupture. If you had the “classical” kind of incision, however, which is an up-and-down vertical cut, you will have a much higher risk of a rupture.
What are the risks of a VBAC?
The majority of risks with a VBAC are minimal and include blood loss and infection, but the main risk is the previous uterine scar tissue breaking open, causing a uterine rupture. A uterine rupture is a very rare, but serious complication.
Will a VBAC work?
The ACOG says that 60-80% of women who attempt a VBAC will be successful.
Ultimately, the decision to pursue a VBAC comes down to you and your doctor. There are many valid medical reasons for choosing one, but there are also valid medical reasons for opting for another C-section as well. To help guide your decision, start with an open and honest conversation about your individual risks, your reasons for choosing a VBAC, and what the safest option would be for you and your baby.