Obstetrics - Vaginal birth after cesarean
Today, doctors know that many women who have had a cesarean delivery can later safely give birth though the vagina. This is called vaginal birth after cesarean (VBAC) delivery. VBAC can be a safe option for many women. However, it is not the right choice for all women, and there are some risks. Of women who try VBAC, 60–80% succeed and are able to give birth vaginally. The success rate varies depending on the reason for the previous cesarean delivery. Other women may try VBAC but need to switch to a cesarean delivery. There are some reasons why a woman may want to try VBAC over cesarean delivery:
- No abdominal surgery
- Shorter hospital stay
- Lower risk of infection
- Less blood loss
- Less need for blood transfusions
VBAC has risks as well as benefits. With VBAC, there is a risk that the cesarean scar may tear during delivery. There also is a risk that the uterus will tear (rupture). Although a rupture of the uterus is rare, it is serious and may be harmful to you or your baby. We at Women’s Health Associates do not feel that a VBAC attempt is wise in the following circumstances:
A previous cesarean section performed through a classical or vertical uterine scar. For cesarean birth, one incision is made in your abdomen and another incision is made in your uterus. Any incision makes a scar. You cannot tell what kind of incision you had in your uterus by looking at the scar on your skin. Your doctor should be able to tell which kind of incision you had by looking at your medical records, if they are available. If your doctor does not know what type of incision you had, you would not be a candidate for VBAC.
- Beyond 41 completed weeks of gestation. All birthing mothers who seek a VBAC will be scheduled for an elective cesarean section to take place at 41 weeks of gestation, based upon our best ability to date the pregnancy.
- History of significant pelvic infection during the previous labor or cesarean birth.
- The presence of a large fetus during the current pregnancy (greater than 9 lbs estimated weight).
- Mother’s Body Mass Index (B.M.I.) of greater than 37 at 36 completed weeks of pregnancy. That would be equivalent to a weight greater than 215 lbs. for a woman 5’4” tall.
- More than one previous cesarean section.
- Previous cesarean section less than 18 months prior to conception for the current pregnancy
Sometimes, when a woman chooses VBAC, she may have to switch to a cesarean delivery during the course of labor. This can happen if problems arise without warning or worsen during childbirth. If problems arise, you may need an emergency cesarean delivery. There is a higher risk of infection for the mother and baby in women who try VBAC and then give birth by cesarean delivery.
Of course, other factors may affect whether VBAC is an option for you. These include problems with the placenta, problems with the baby, or certain medical conditions during pregnancy. For example, a woman can still try VBAC when her pregnancy continues past her due date. However, vaginal birth after cesarean delivery may not be a good option if the doctor decides that there is a need to induce labor (use drugs to help labor begin).
We ask our patients to appreciate the significant medico-legal burdens placed on obstetricians and midwives who offer VBACs to their patients. There are many hospitals in this country that adamantly refuse to offer the option of VBAC to their patients. We at Women’s Health Associates firmly believe that women must be offered choice in the birth of their children. We continue to support that choice whenever possible.