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Know Your Options: Vaginal Birth After Cesarean (VBAC)

Though many people are familiar with the term cesarean section (C-section), vaginal birth after cesarean (VBAC) is perhaps a less common one. The mantra of doctors used to be, “once a C-section, always a C-section,” but it is possible, and potentially better in some cases, to deliver vaginally after a prior C-section.  With success rates ranging from 60-80%, attempting a vaginal birth through a trial of labor after cesarean (TOLAC) is an option worth considering.

While there are exceptions, generally the risks of vaginal delivery remain lower than the risks of C-section. Although riskier than a first-time vaginal birth, research has indicated that VBACs can be a very safe alternative to repeat cesareans.  Benefits of a VBAC instead of a repeat C-section include fewer complications, shorter recovery time, more participation at the birth, and impact on future pregnancies (repeat c-sections get more complicated each time, whereas VBACs get easier). 

Still, VBAC isn't right for every woman.  Sometimes a pregnancy complication or underlying condition prevents the possibility of a successful VBAC.  Early in her pregnancy, an expectant mother should discuss every option with her physician or clinician to determine what is best for her and her family. Here is a review of the risks associated with VBACs, factors affecting their success, and the benefits of vaginal birth.

Risks associated with VBACs:

  • While occurring less than 1% of the time, the greatest risk of a TOLAC is the rupture of a scar from a previous C-section or rupture of the uterus itself. Hospitals must be equipped with a surgical and anesthesia team should an emergency C-section be needed.
  • TOLAC is not advised for women who have had any prior uterine ruptures or other abdominal scars.
  • Mothers who do not succeed with a TOLAC are more likely to need a blood transfusion and are more susceptible to uterine infection.

Factors increasing the chance of a successful VBAC:

  • Previous vaginal delivery
  • Being younger than 35
  • Natural versus induced labor
  • Reason for previous C-section not likely to recur, such as breech (feet-down) presentation or fetal distress
  • Prior C-section not done for stalled labor
  • Low-transverse (side-to-side) incisions, which carry the least chance of rupture

Factors decreasing the chance of a successful VBAC:

  • Being overweight
  • Being older than 35
  • Pregnancy beyond 40 weeks
  • High birth weight of the baby (more than 9 lbs.)
  • Pregnancy-induced hypertension
  • Short time span between pregnancies (fewer than 18 months)
  • Multiple prior C-sections
  • Prior C-section caused by difficult labor (dystocia)
  • Chronic conditions, such as diabetes, heart disease, or high blood pressure, that can affect vaginal birth
  • Small pelvis that may not be able to handle vaginal birth
  • High-vertical (up-and-down) incisions, which carry the most chance of rupture

Benefits of vaginal versus surgical birth:

  • Faster recovery time
  • Shorter hospital stay
  • Prevention of potential surgery complications, including blood loss, infection, anesthesia risks, injury to bowel and urinary tract, blood clots in the leg, and death (maternal death rate is 13 per 100,000 for C-section, more than three times the rate for vaginal birth)
  • Reduced risk of complications associated with multiple C-sections, including hysterectomy and problems with the placenta
  • Reduced chance for a blood transfusion
  • Easier time with breastfeeding without an abdominal incision
  • Emotional benefits of successful vaginal birth

Insurance companies normally cover the cost of VBACs. Women’s Health Connecticut is committed to providing women with the education they need to make the most informed decisions about their health. If you are interested in a VBAC, request an appointment with one of our providers today.

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