VBAC stands for vaginal birth after cesarean. If you wish to try a vaginal delivery after having had a cesarean, you should know that a lot of women who have undergone cesarean deliveries are candidates for VBAC. Statistically, the highest rate of VBAC involves women who have experienced both vaginal and cesarean births and given the choice, have decided to deliver vaginally.
The greatest concern for women who have had a previous cesarean is the risk of uterine rupture during a vaginal birth. If you have had a previous cesarean with a low transverse incision, the risk of uterine ruptures in a vaginal delivery is very low. Some studies have documented increased rates of uterine rupture in women who undergo labor induction or augmentation. You should discuss the possible complications associated with induction with your health care provider.
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Reasons for Having a VBAC
Here are some following reasons many women have been given for a cesarean:
Dystocia: Dystocia refers to a long and difficult labor due to slow cervical dilation, a small pelvis, or a big baby. Many women who are given this reason for previous cesareans and deliver vaginally the next time around tend to give birth to a larger baby than their first.
There is not evidence that a large baby requires a cesarean. The pelvis and the baby’s head are not rigid structures and both mold and change shape to allow birth. During labor there are certain techniques that a woman can use to help open up the pelvis, thus allowing the birth of a large baby. Also, tests such as ultrasound are not reliable resources to tell how big a baby is.
Genital Herpes: For many years, because of the risk of passing herpes to the baby during delivery, women with a history of herpes have almost always delivered by cesarean. Physicians would examine cultures in the last weeks of pregnancy and if they found the active virus, they would schedule a cesarean. Today, it has been determined that unless there is a physical lesion, it is okay to give birth vaginally.
Fetal Distress: If the life of the baby is at risk from fetal distress or other complication, there is little doubt that most mothers will consider a cesarean delivery. Fetal heart rate monitoring to detect fetal distress can be a routine part of the VBAC procedure.
Criterions for VBAC
There is certain criterion that should be meant for a woman to have a VBAC, which includes:
- No more than two low transverse cesarean deliveries.
- No additional uterine scars, anomalies or previous ruptures.
- Your health care provider should be prepared to monitor labor and perform or refer for a cesarean if necessary.
- Your birth location should have professionals available on weekends and evenings in case a cesarean is necessary.
- If the original reason for a cesarean delivery is not repeated with this pregnancy.
- You have no major medical problems.
- The baby is a normal size.
- The baby is head-down.
Women Who Can Plan for a VBAC
- Women with one or two low horizontal uterine scars or a low vertical scar.
- Women who had one vaginal birth or not. Women who had a cesarean for a “big” baby, “failure to progress”, a breech, or non-reassuring fetal heart tones (fetal distress).
- Some women expecting twins or a “big” baby.
- Women who go past their due date or go into labor before their due date and the baby is expected to be of normal weight.
- Women who will labor for a VBAC 18 to 24 months after their prior cesarean.
- Women who may want an epidural for pain relief.
Many women believe that the only safe choice after a cesarean is another cesarean. Social pressure plays a huge role in a woman’s decision and is greatly influenced by persistent and pervasive myths about vaginal birth after cesarean (VBAC).
4 Common Myths about VBAC
Hospitals ban VBAC because it’s such a serious and unusual complication that they cannot manage it appropriately. Hospitals with labor and delivery units have protocols in place to respond to obstetrical emergencies. The guidelines used to manage the complications from first time moms and repeat cesarean moms are also used to address uterine rupture in VBAC moms.
- There is a chance that either baby or mom will die during a VBAC. The risk of death is very low for baby or mom. The most serious cesarean-related complications become more likely as an individual woman has had more cesareans.
- I can’t have a VBAC in my state because it’s illegal. A VBAC is legal throughout America.
- VBACs can’t, or shouldn’t, be induced. When a mom or baby develops a complication that requires the baby be born sooner rather than later, but not necessarily in the next ten minutes, induction can make a difference between a VBAC and a repeat cesarean.
Although most VBACs are seen in hospitals, many VBACs are successfully done at home. Although most healthcare providers worldwide do not recommend laboring for a VBAC at home, many women are choosing to have a VBAC at home rather than be forced to have a repeat cesarean when no medical reason exists.
Although some women plan to have their VBAC at home, to date there is not enough information about the health outcomes of home VBACs. So it’s difficult to know. Some caregivers support women who want a home VBAC and have established a relationship with a local medical facility and a physician in case of complications.
8 Questions to Consider before Having a VBAC
If you are thinking of having a VBAC at home, keep these things in mind:
- How far is the nearest medical facility?
- Who will go with you?
- How will you get there?
- How will you be cared for until you arrive?
- When you arrive will the medical staff be ready to care for you?
- Will there be an obstetrician available?
- Will there be an operating room available if you need surgery?
- Will there be appropriate emergency care for your newborn if needed?
Although many hospitals have stopped providing care for women who want to plan a VBAC, there are resources you can access. At this time, in the United States all Level III hospitals, those that have emergency obstetric services available at all times and a neonatal special care nursery meet the current ACOG recommendations for VBAC. These are usually large hospitals affiliated with a medical school. Call the hospitals covered under your medical insurance plan and ask if they support VBAC. You can also access childbirth educator and doula organization websites. Find members’ names in your city or state. They may be familiar with VBAC-fr iendly providers.
8 Notes and Facts about Having VBAC
It is important to do all your research when making the decision to do a VBAC. Here are some other notes and facts to keep in mind.
- VBACs are not usually recommended if you have vertical or T-shaped C-section scars. These types of incisions are more likely to result in uterine rupture, so VBACs are generally only a good idea for women who have low-transverse uterine scars — horizontal scars right above the bikini line.
VBACs can be an excellent choice if you’ve ever had a vaginal birth. Research suggests that if you have already delivered a baby vaginally, even if it was before your cesarean, your likelihood of having a safe and successful VBAC is higher.
- VBACs are more likely to succeed if your labor starts spontaneously. Inductions do not work that well for VBACs, because doctors cannot use as many labor-inducing medicines on women who have uterine scars. Induction ups your risk for uterine rupture. That is not to say that VBAC inductions cannot be done, but if you are laboring on your own, you are making progress on your own which is great for VBAC success.
- VBACs can be less successful if you are overweight/obese or if you gained a lot of weight between your pregnancies. Studies have reported that VBAC success was lower among women who gained more than 40 pounds during pregnancy compared to women who gained less than that amount. Overweight and obese women who attempt VBAC’s are also less likely to successfully deliver vaginally in general.
- VBACs may be more risky if your baby is large. Recent research has found the chance of VBAC failure is higher when babies weigh more than 8 pounds 13 ounces at delivery compared to when they weigh less than 7 pounds 11 ounces. VBACs with large babies may also increase the risk of uterine rupture and perineal tears which is part of the reason why some doctors do not perform VBACs on women who are more than a week past their due date. That said, just because you had a large baby before does not mean you will have one this time.
- VBACs can be an option even if you have had two cesareans, assuming both involved low-transverse uterine incisions.
- VBACs may be smart if you want to have a lot of kids. If you are pregnant with your second or third child and you know you want more kiddos down the line, a VBAC might be wise because elective cesareans become more dangerous the more you have. Plus, if you have a successful VBAC now, your chance of a successful VBAC in the future goes up, too.
- VBACs are more successful the younger you are. The younger you are, the fewer complications.
Although it is frustrating, there is no clear-cut answer whether you should have a VBAC or not. There is a lot of research to be done. It is important you find a health care provider that is supportive in your choices and knowledgeable with VBACs. This will also help you have a successful VBAC and you will feel confident. Also, hiring a doula to support and assist you with your labor is a great idea. Hiring a doula that may have some VBAC experience may be even better. Do not let myths and society scare you into having a repeat cesarean if that is truly not what you want.