Vaginal birth after c-section (VBAC)


The old phrase "once a C-section always" is no longer true. In the past, the belief was that if a woman had delivered one baby by C-section, all other children had to be delivered the same way. Today many women can have vaginal deliveries after a previous C-section delivery. This is referred to as a vaginal birth after cesarean (VBAC). Attempting to have a vaginal birth after a previous cesarean section is called a trial of labor after cesarean (TOLAC).

Candidates For VBAC

According to the American College of Obstetricians and Gynecologists (ACOG), the following women are candidates for VBAC:

  • The woman has had no more than two prior low-transverse C-section delivery. This refers to the cut on your uterus, not the one on your belly. If you’ve had a prior c-section, your health care provider may ask you to get a copy of the report from your first surgery to check what type of incision you had on the uterus.
  • The woman has had no other uterine scars or ruptures, whether from previous C-sections or other surgeries.
  • The woman has a pelvis large enough to allow a vaginal delivery.
  • Delivery will be at an institution with a physician immediately available throughout active labor who can monitor the fetus and perform an emergent C-section if needed.
  • Delivery at an institution where anesthesia and staff is also immediately available if an emergent C-section needs to be performed.

ACOG has specifically stated that whenever a woman is planning a VBAC delivery, there should be an appropriate medical team available, including an anesthesiologist, throughout the active labor so that an emergency C-section may be done if necessary. Smaller hospitals may not have the resources to monitor a VBAC delivery or to provide an emergency c-section for VBAC situations, and VBAC delivery may not be possible.

Women Who Should NOT Have VBAC

One of the main concerns with having a vaginal delivery after a C-section is the potential rupture of the uterus, which could be harmful to you and the baby. Therefore, ACOG has made recommendations for women who should not try a VBAC delivery. These women include:

figure 1

Vaginal Birth after C-Section Fig. 1
  • Women with a high vertical (or classical, T-shaped) incision on the uterus
  • Women with a history of extensive uterine surgery
  • Women with a small pelvis or delivering a large baby - it may not be safe for the baby to pass through the pelvis (fig. 1)
  • Those with a medical problem or obstetric condition, such as placenta previa or abrubtio placenta
  • Women delivering in a hospital without an available medical team for VBAC monitoring and emergency C-section
  • Prior uterine rupture
  • Women with two prior C-sections and no previous vaginal deliveries
The Benefits of VBAC:
 
Statistically, about 60-80% of women who try VBAC are able to deliver vaginally. If you are considered a candidate for VBAC, there are some advantages to having a vaginal delivery over a C-section. Some of these include:

  • Shorter hospitalization
  • No abdominal surgery
  • Lower risk for blood transfusion and infection
  • Overall faster recovery
  • May avoid multiple future c-sections if you are considering a large family (with three or more children)
Notably, however, some women who try to have a vaginal delivery end up with a c-section. They don’t get to experience these benefits.

Risks:

The most serious risk with VBAC is rupture of the uterus. The risk of rupture of the uterus after a prior low transverse c-section is about 1 percent, whereas the risk of rupture of the uterus in previous classical C-section is 8 to 10 percent. In a recent large study, about 1 in 2,000 women who tried to VBAC had a uterine rupture that caused permanent brain damage for the baby. Women in the group that tried to have a vaginal delivery were also more likely to need a blood transfusion and more likely to have an infection in their uterus that required antibiotics. On the other hand, about three quarters of the women who tried to have a vaginal delivery succeeded. These women avoided surgery and had a quicker recovery compared with the women who chose to have a scheduled repeat c-section.

The Final Decision is Yours:

The key to making a decision about VBAC is to discuss with your health care provider the risks and benefits for both you and your baby. The circumstances are different for everyone, and it is important to seek guidance from your health care provider to discuss your risks.

Ultimately, the decision is yours. The more information and understanding you have about VBAC, the easier it will be to make a decision.

Review Date: 12/1/2010
Reviewed By: Zev Williams MD, PhD, FACOG, Reproductive Medicine and Infertility, Weill-Cornell Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com
 

Existing Members


 
Forgot Password?

Featured Partner

Life Pilates

Life Pilates Vancouver, pilates designed to build balance and efficient movement patterns. Just what a pregnant or post-partum body needs! Mention YourBabyYourWay.com to get 15% off  a single lesson or $65 off a 10-lesson package. See all offers >
 
Did you/will you get the flu shot while pregnant?

 

View Polls Archive

FREE

 Resource Guide for
  Pregnancy & Newborn
   Care — download now
    (3.5MB Adobe PDF).
 

Local Angle

 

Howe family photo

Encouragement + An Assist = Success

Nine days past her due date, Sara Howe was awakened at 3:00AM when her water broke. Thrilled that the long wait was finally over, Sara and her husband David packed up and headed to PeaceHealth Southwest Medical Center. By 5:00AM they were comfortably settled into one of PeaceHealth Southwest’s Labor Delivery Recovery and Postpartum rooms, ready for action. But four hours later, Sara contractions had still not progressed so her midwife started her on Pitocin. Soon the contractions kicked in and Sara was well on her way.

At around eight o’clock the next morning, it was time for Sara to start pushing. So she pushed. And she pushed, and she pushed, and she pushed. "The first few hours of pushing went by without me realizing the time," remarked Sara. "But around the fourth hour I started to wonder if I was still making progress. That is when the encouragement of my midwife, husband and the PeaceHealth Southwest nursing staff kept me going. It was like I had my own cheering section."

Unfortunately, even with all the support and encouragement, Sara’s labor was not progressing because her baby’s head was tilted in the birth canal. Neither Sara or her midwife wanted her to have a Cesarean section after all that work, so her midwife suggested an assisted delivery. Read more >

Share your story. Submit your story with a local angle, and you could receive a free gift if it is selected for publication.