Is it possible to have a VBAC?

Many women who have had a previous cesarean section (C-section) wonder if it's possible to have a vaginal birth after cesarean (VBAC). For many women, the answer is yes! Whether your C-section was planned or a surprise, a VBAC birth can be possible and safe.

In the past, women who had a previous cesarean section during the birth of their first child would often have another one when giving birth to more children. Repeat C-sections were considered standard practice to avoid potential health risks. Today, though there are still some risks to consider, about 75% of women who have had a previous C-section and are appropriate candidates for a trial of labor after a cesarean section (TOLAC) and are able to have a successful vaginal birth.

Who is a good candidate for a TOLAC?

Certain factors may make a vaginal birth after cesarean delivery safer or riskier.

At Reid Health, a TOLAC may be appropriate for women who:

• Have had one previous low transverse c-section.
• Have no history of problems with their uterus
• Have no additional scarring on their uterus
• Have had a successful vaginal birth in the past

Having a successful VBAC may be more difficult or pose additional risks for women who:

• Are over age 35
• Are overweight
• Have had more than two C-sections in the past
• Have preeclampsia, a type of pregnancy-related high blood pressure
• Have a pregnancy that lasts for 40 or more weeks

The type of incision made to the uterus during past cesarean sections also impacts the safety of a VBAC. Women who had an incision made across the base of the uterus (a low-transverse incision) during previous C-sections are more likely to have a successful VBAC than those who had another type of incision.

It's important to know that the incision made to the uterus is different from the incision made in the skin during a C-section. Check your medical records if you're unsure what type of uterine incision was made during your past C-section.

The National Institute of Child Health and Human Development (NICHD) offers a calculator to estimate the likelihood of having a successful VBAC. The calculator does not guarantee any outcome, positive or negative, but it may offer some insight that you can discuss with your provider.

What are the risks and benefits of having a VBAC

VBACs also have risks and benefits. Knowing what they are can help you make a well-informed decision.

The biggest risk of attempting a TOLAC is the possibility that a scar on the uterus from the previous C-section could open unexpectedly during labor or delivery. This is called a uterine rupture which happens in less than 1% of VBACs. But if a uterine rupture does occur, it can be very dangerous for both the mother and the baby.

One of the biggest benefits of having a VBAC is avoiding another abdominal surgery. Other benefits of VBAC may include:

• Faster recovery time
• Higher chance of being able to have more children later
• Lower chance of infection
• Lower risk of excessive blood loss or need for a blood transfusion compared to C-section
• Lower risk of injury or needing a hysterectomy

What are the risks and benefits of having a repeat C-section

Risks of a repeat C-section may include:

• Additional C-sections increase the chance of uterine rupture and placenta complications in future pregnancies
• Blood clots, especially in the lungs, legs, or pelvic organs
• Higher risk of excessive blood loss or need for blood transfusion
• Higher risk of infection compared to a VBAC
• Higher risk of needing a hysterectomy
• Injury to the organs and tissues around the uterus
• Longer hospital stays
• Reaction to anesthesia or medication used in the procedure
• Repeat cesareans may make it more difficult to have children in the future

On the other hand, sometimes a repeat C-section is needed and can actually be beneficial.

• Factors that make C-sections necessary, and sometimes repeat C-sections, include:
• Baby is breech (positioned so that their buttocks or feet are coming out first) or positioned diagonally or sideways, also known as transverse presentation.
• Abnormalities or complications with the placenta
• Baby is experiencing umbilical cord or heart rate abnormalities
• Baby is too big for a vaginal birth
• Labor does not progress as expected
• The mother has an infection or health condition that may be harmful to the baby or difficult to control during labor
• There are two or more babies (a multiple pregnancy)

What can I do to have a successful VBAC?

Deciding to try for a VBAC is a big decision. Talking with your provider about the risks and benefits, along with your personal medical history, is the first step.

No matter what type of birth you have, it's important to take care of your health during pregnancy by eating healthy and receiving routine prenatal care. You can also learn relaxation techniques before your due date, like breathing exercises or massage to help manage pain during labor.

Keep in mind, no matter how prepared you and your provider are for your VBAC, the unexpected can happen. You may still need a repeat C-section if problems come up during the TOLAC process. If this happens, talk with your provider afterward if you have any concerns or questions. And if you have any signs of postpartum depression, anxiety, or stress, seek support and don't go through it alone.

Reid Health OB/GYN providers are by your side every step of the way. Request an appointment to talk with us about your pregnancy and birth plan.