Can I Try a Vaginal Birth After a C-Section (VBAC)?
Some women who have delivered a baby by c-section (Cesarean section) would like to have their next baby by vaginal delivery. This procedure is called Vaginal Birth After C-Section or VBAC. By choosing VBAC, women are choosing to avoid the risks and long recovery of surgery. Others want the experience of a vaginal delivery.
Studies show that VBACs are more risky for the woman and baby than a repeat c-section. The most serious danger of VBAC is the chance that the c-section scar on the uterus will open up during labor or delivery. This is known as an uterine rupture. While extremely rare, uterine rupture is very dangerous for the mother and the baby. Less than 1 percent of VBAC lead to uterine rupture. Even so, uterine rupture can lead to life threatening bleeding for the mother and brain damage or even death for the baby.
In a study of over 30,000 pregnant women who had prior c-sections, 73% had successful VBACs. The remaining 27% tried to deliver vaginally, but ended up having another c-section. While rare, problems with the mother and the baby were more common in the VBACs compared with the repeat c-sections. Only 0.8% suffered a uterine rupture. Women who tried VBACs required more blood transfusions and a greater risk of endometriosis than those who had repeat c-sections. Babies born by VBAC had a higher risk of brain damage than those born by repeat c-sections.
The number of VBACs is dropping in the United States for a number of reasons. Doctors and hospitals are threatened by the number of possible lawsuits brought on by unsuccessful VBACs. Stiff guidelines are often imposed, requiring a standby surgical team be available during a VBAC. The expense and the risk, the health care workers construe, are just too high. Doctors are also discouraging or simply refusing to perform VBACs. Often this is because their affiliated hospital doesn’t allow them to. In other cases, doctors cannot get malpractice insurance to cover claims related to VBAC.
The decision to try VBAC is a serious one. Discuss the pros and cons with your physician and understand his/her level of confidence in the matter.
VBAC Considerations
Doctors may evaluate some of the following considerations when making the decision whether or not to go ahead with a VBAC:
- A women has had 1 previous planned c-section done with a low horizontal cut (bikini incision)
- A woman has no other uterine scars (aside from the prior c-section) or problems
- A woman has no known problems with her pelvis
- A doctor is present during all the labor and delivery and can perform an emergency c-section if needed
- An anesthesiologist and others of a surgical team are standing by in case an emergency c-section is required
The decision is not an easy one, nor should it be. The risk of a VBAC has its positives and negatives. Do your research and know yourself. Have serious conversations with your doctor, then make the decision for VBAC or not.
