According to statistics revealed by the Childbirth Connection (a program of the National Partnerships for Women and Families), it’s common for more than one in five U.S. women to give birth to their first child through C-section. If this has happened to you, then don’t despair as there’s still a chance for you to have a Vaginal Birth After Caesarean (VBAC).
To be honest, your doctor may even recommend that you have a VBAC. Believe it or not, but the American Academy of Obstetricians and Gynecologists actually encourages doctors to attempt VBACs over elective C-sections in as many cases as possible.
The thing with VBACs and repeat C-sections is that both these birthing options have their respective benefits and risks. As the National Institute of Health puts it, the safest means of delivering a baby for women who have previously had a C-section is through a successful VBAC – and for the record, VBACs have a 60-80% success rate, whereas babies are delivered by C-section in the rest of the cases.
To help you decide whether an elective C-section or a VBAC is right for you, here are a few things that you should know about having a Vaginal Birth After Caesarean:
7 Your Chances of Giving Birth Vaginally After Having a C-section
There’s a good chance that you‘ll succeed in giving birth vaginally after a C-section as long as you’re an appropriate candidate for it. With that, your chances of giving birth successfully vaginally will be higher if the reason of your first C-section won't be an issue the second time around. For instance, if you’ve already had an easy vaginal delivery and then had a C-section because your second baby was breech, then you will have higher chances of having a successful VBAC.
However, your chances will be lower if you had an emergency C-section after being fully dilated and pushing for hours with your first baby who was small and properly positioned. What this means is that having previously given birth through the vagina will assist in boosting your odds rather significantly.
But to be honest, it’s nearly impossible for anyone to predict with any degree of certainty as to whether they’ll be able to have a vaginal delivery or not. For the record, attempting a VBAC is known as a ‘Trial of Labor After Caesarean (TOLAC).’ Statistics suggest that nearly 60 -80% of women who attempt to have a VBAC are able to give birth vaginally.
A few considerations
If you wish to go ahead with a VBAC, it’s vital for you to find a caregiver who supports the idea. She should also have admitting privileges at a hospital that support VBACs. Remember, not all hospitals offer a VBAC considering that they’re controversial and may lead to legal issues for the facility.
6 Are You a Good Candidate for a VBAC?
There are certain criteria set by the American College of Obstetricians and Gynecologists that you need to meet in order to be considered a good candidate for a vaginal birth after a C-section. To begin with, it’s necessary for your previous caesarean incision to be a low-transverse uterine incision (one that is horizontal) instead of a vertical incision made on your upper uterus (a classical incision) or T-shaped as these would put you at higher risk of uterine ruptures.
What you should note here is that the type of scar on your belly may not match the one present on your uterus. Next, it’s vital for you to have a large enough pelvis through which your baby can pass safely. Although there’s no way for anyone to know this for sure, it’s possible for your practitioner to make an educated guess by carefully examining your pelvis.
The ideal candidate for a VBAC should also not have had any other extensive surgery involving the uterus. This includes having a myomectomy for the removal of fibroids. Also, to be able to attempt a VBAC, it is necessary for you to have never experienced a uterine rupture.
Other criteria for a good candidate
To be able to qualify for a VBAC, it’s important for you to have never had any medical condition or obstetric problem like a large fibroid or a placenta pervia that would make it risky for you to have a vaginal birth. Remember, when attempting a VBAC, it’s also necessary for you to have a doctor on site who has the ability to monitor your labor and perform an emergency C-section if need be.
5 Increasing the Likelihood of Giving Birth Vaginally
There are certain steps that you need to take in order to raise your chances of giving birth vaginally after a C-section. To begin with, it’s extremely important for you to choose a doctor or midwife who is supportive of VBAC. Unfortunately, the changing cultural views that we have of C-sections, vaginal births and VBACS together with fears of legal claims and lawsuits have limited the numbers of midwives and doctors who would want to attempt a VBAC.
Finding such a doctor or midwife is going to fairly hard for you. For this reason, it’s best for you to discuss your preferences and goals with potential caregivers and find out if they’re willing to help you meet your goals. In case they do not give a satisfactory response, it’s best for you to seek a better option elsewhere.
The next step that you can take is to hire a doula. The fact of the matter is that your previous labor ended in a C-section and there is a lot of bias against VBAC which may add to yours and your partner’s anxiety during a VBAC labor. The doula you hire will be a trained, experienced woman who will easily be able to help you pull through this. She will know what to do to help you relax, promote labor progress and ease pain.
Commit yourself to giving birth vaginally
To be able to give birth vaginally, it’s of utmost importance for you to commit yourself to it. Your request is most likely going to be granted if you ask for a caesarean in a weak moment – don’t.
4 The Benefits of Having a VBAC
Quite a few benefits are associated with having a VBAC. A successful VBAC makes it possible for you to avoid major abdominal surgery, which eventually means you won’t have to put up with the risks associated with a C-section. What risks are we talking about here? Well, the risks include a higher risk of excessive bleeding--which can lead to a blood transfusion or in rare cases, a hysterectomy which increases the risk of developing certain infections during the procedure.
What should be noted here is that all the potential complications of major abdominal surgery continue to increase with each caesarean delivery as the scarring that occurs can make each procedure a tad bit more technically difficult. With a VBAC, you won’t have to stay long at the hospital. However, if you have a C-section, you will have to stay for a longer period at the hospital and your recovery is going to be much slower and far more uncomfortable.
Most importantly, a VBAC saves you from future complications that are associated with having repeat C-sections. For instance, if you plan to have more children, a VBAC will reduce your chances of facing conditions like placenta accrete and placenta previa – these are life-threatening conditions and their chances increase with each repeat C-section.
A few more benefits
Having a VBAC also helps avoid having another scar on your uterus. This is extremely important in case you wish to have more children later on in life as the scars of a C-section on your uterus can create problems with a later pregnancy. A VBAC is also less painful to recover from and there’s a much lower risk of infection.
3 The Risks of Attempting a VBAC
Like many other things in life, having a VBAC comes with its fair share of risks too. Even if you’re the ideal candidate for a VBAC, there’s still a small risk that your uterus is going to rupture during labor at the site of your C-section incision. The worst part about this is that it can prove to be deadly for your baby as he will be left oxygen deprived and you’ll also experience severe blood loss.
To make things worse, if you end up not being able to give birth vaginally, you would have endured all those hours in labor only to find yourself having an unplanned C-section. Although a successful VBAC is far less risky than a scheduled repeat C-section, having an emergency C-section because your VBAC was unsuccessful is far more risky than a scheduled C-section.
If you have an unplanned C-section after the onset of labor, there’s a higher chance of surgical complications including excessive bleeding, infections of the uterus and the incision site and even the necessity of having a blood transfusion due to severe blood loss.
Your baby will be at risk too
Last, but not the least, there’s the risk of the baby having a serious complication that could lead to long-term neurological damage or even death. Although this risk is extremely small, it may be higher in women who undergo an unsuccessful VBAC (which would mean a C-section after failed labor) than in women who have a successful vaginal delivery or a scheduled C-section.
2 Tests and Exams that Need to Be Performed for a VBAC
Your doctor is going to take extra measures apart from the usual prenatal tests to determine whether having a vaginal delivery is a safe birthing option for you or not. On the whole, these extra measures are simply going to help you and your doctor make a well-informed decision as to whether you wish to have a VBAC or a planned C-section while considering their benefits and risks.
The assessments that your doctor will perform sometime during your pregnancy to figure out whether it is safe for you to attempt may include:
- A fetal ultrasound
- A review of your previous surgery records so as to verify the type of incision that was used in your previous C-section
- Fetal heart monitoring, which will also be used during labor and delivery to watch for fetal distress. This may also be used for the detection of a sudden uterine rupture. For the record, a rupture is followed by a sudden and ongoing drop in the fetal heart rate together with the mother experiencing severe bleeding and pain
Interventions that may be needed during a VBAC
One of the earliest signs that something is wrong is a change in your baby’s heartbeat during labor. For this reason, if you try for a vaginal birth after a C-section, it will be necessary for continuous electronic fetal monitoring to be used. Apart from that, you’ll also require an IV while refraining from eating anything during labor in case you may need to have an emergency C-section.
1 Recovery After a VBAC
Recovery after a VBAC is fairly similar to recovery after vaginal birth. To begin with, it may be possible for you to go home with your baby within 24 to 48 hours depending on your condition and that of your baby. On the other hand, if you have a C-section, it won’t be possible for you to go home from the hospital before 2-4 days and even when you do, you will have to put up with a period of limited activity so that your incision can heal without complications.
On the whole, the risk of infection is low for both vaginal and C-section deliveries, but it is much lower after a vaginal birth. Prior to leaving the hospital, you will be given a list of signs of infection that you need to watch out for in the first few weeks after delivery. On the whole, recovering from a VBAC is going to be much easier as compared to recovering from a C-section.
What about pain medication?
Like most vaginal births, it’s possible for most women who chose to have a VBAC to safely use pain medicine during labor. During a VBAC, pain medication is typically given when the cervix has dilated at least 3-4cm.
The types of pain medicines that may be administered include local anesthesia, an epidural to numb the entire lower part of your body (fairly safe during VBAC as it does not increase uterine rupture rates), and opioids (narcotics) to help you relax and partially relieve pain. In case your labor stops progressing or slows down, your doctor may also choose to use oxytocin to strengthen contractions.