A vaginal birth after a cesarean (VBAC) is the vaginal delivery of a baby after a cesarean procedure of a previous pregnancy. It was at one time thought to be unsafe for a mother to attempt a VBAC, and a woman was often told she must schedule a C-section for all her future pregnancies. Although, many recent studies have found that a VBAC can be a safe option under the right circumstances.
If you are pregnant and have experienced a cesarean delivery in the past, talk to your OB-GYN about a potential VBAC birth plan. They will review all the details of your C-section and help determine if you’re a good VBAC candidate. They will also educate you on what to expect during a VBAC.
Is It Safe to Have a Vaginal Birth After a C-Section?
A VBAC comes with some risks, although many women can have one without complications. According to the American College of Obstetricians and Gynecologists, 60%- 80% of women who have previously undergone a C-section can successfully give birth vaginally.
If you’re interested in a VBAC, your OB-GYN can help weigh the risks and benefits. It’s also important to check with your hospital to make sure they allow it.
What Is a Uterine Rupture?
The main concern associated with VBAC is a uterine rupture. A uterine rupture is when the pressure of labor causes the scar from your previous C-section to rupture open. While this can be a life-threatening complication for both the mother and baby, it’s very rare.
Serious health risks of a uterine rupture include:
- Blood loss
- Blood clots
- Bladder damage
Certain circumstances can increase your risk of a uterine rupture, including the location of your C-section scar. Research has shown that the risk is as low as 0.9% (1 out of 100) if you've had a previous C-section with a horizontal scar (transverse). Although, if you have a vertical scar, a VBAC may not be an option because the risk of uterine rupture is too high.
Your Previous C-Section Scar, and What It Means for VBAC
As mentioned above, the location of your scar can decide if an attempted VBAC is safe or not, so it’s extremely important to discuss this with your OB-GYN. It’s also important to understand that the scar on your abdomen does not necessarily reflect the scar on your uterus. If you are unsure of your incision location, the information can be found in your medical history.
There are three different types of C-section scars:
- A low transverse incision is a horizontal cut made at the lower, thinner part of the uterus. This is the most common incision made and has the lowest risk of uterine rupture.
- A low vertical incision is a vertical cut made in the lower, thinner part of the uterus. It has a higher risk of uterine rupture than a low transverse incision, but the risk is still very low.
- A high vertical incision is a vertical cut made in the upper part of the uterus and has the highest risk of a uterus rupture. Your OB-GYN will strongly advise against a VBAC if you have a high vertical incision.
Why Should I Consider a VBAC?
There are many reasons why a woman may be interested in attempting a VBAC, including the desire to experience vaginal delivery. A VBAC can also help reduce the risks associated with multiple C-sections, such as infection and injury to adjacent organs.
Other benefits of a successful VBAC include:
- No abdominal surgery
- Shorter recovery period
- Less blood loss
If a woman is interested in a VBAC, she should talk to her OB-GYN early in her pregnancy. If it's decided that VBAC is an option, it's important to create a VBAC birth plan and understand that an emergency C-section may be needed at any point during delivery if the mother or baby's health is at risk.
Are You a Good Candidate For a VBAC Birth Plan?
Your chances of having a successful VBAC increase if:
- You have had no more than two previous C-section deliveries
- Have had a vaginal delivery in the past
- Have no other uterine scars or abnormalities
- Have a low transverse incision scar
- You are under 35 years old
- You’ve already had a successful VBAC without any complications
If your baby's health was the reason for your previous C-section, not the actual labor process, you also have an increased chance of a successful VBAC. Examples of this can include a breech baby or an abnormal fetal heart rate tracing.
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Reasons Why Some Women May Not Be Able to Have a VBAC
It’s crucial you and your baby are in good health to consider a VBAC. Circumstances where a doctor will strongly advise against trying a VBAC include:
- Past your due date
- Having a large baby
- Multiple C-Sections
- Health complications
- Incision location (high vertical incision)
- You are 35 or older
- Induced labor
- Hospital is not equipped for an emergency C-Section if something goes wrong with the VBAC
Your doctor may not completely reject a VBAC if you fall into one of these categories. Instead, they will talk to you about the higher risks you may have and the potential of having an emergency C-section during a VBAC attempt. If your doctor does reject your VBAC request, it’s important to discuss why they feel it is not medically safe.
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Questions to Ask Your Doctor About a VBAC Birth Plan?
It’s important you discuss your medical history and ask any questions you have about your VBAC birthing plan.
Some topics to discuss include:
- Previous pregnancies and deliveries.
- Reason why you had a C-section.
- Safety of VBAC and a repeat C-section for you and for your baby.
- Reasons why you should or shouldn’t consider VBAC.
- Reasons why you should or shouldn’t consider repeat C-section.
- Plan for inducing labor (or not).
- Ability of the delivery facility to manage emergency delivery complications.
- Your plan for more children.
Having an open and honest conversation with your OB-GYN can help you both develop a VBAC birthing plan. However, it’s important to be flexible because your birthing plan can change during your pregnancy for any reason.
You will likely have a lot of questions while creating your birthing plan, we are here to help. Download your free pregnancy planning kit here!
If you’re interested in a VBAC, our trusted physicians at Moreland OB-GYN can answer any questions you have and talk about your options. Together, we can determine if a VBAC birthing plan is a safe choice for you and your baby.
We will walk with you through every step of your pregnancy journey, and reevaluate your birthing plan at each late-term visit. We are here to help you feel prepared and confident when your due date approaches. Schedule a visit today!