In the past, physicians and women alike assumed repeat c-sections were necessary to ensure the safe delivery of babies when the mother had previously delivered via cesarean. However, research indicates the contrary. For appropriate candidates, the risks of vaginal birth after a prior c-section are no more than those of other vaginal births.
Vaginal birth after cesarean (VBAC) is possible, even if you are carrying twins or have already had two c-sections.
Trial of labor after cesarean (TOLAC) allows women who have previously had a c-section to be monitored closely and safely delivery their baby vaginally.
For women who are appropriate candidates, there are many benefits to delivering vaginally, regardless of previous cesarean birth.
The risks of vaginal birth after cesarean are similar to those of any vaginal birth.
What is a VBAC?
VBAC is the acronym for vaginal birth after cesarean. Previously, c-section deliveries were required if the woman had delivered via c-section in the past. However, recent research indicates that this common practice is unnecessary in many cases. With the appropriate candidates, VBAC has shown to be 75% successful. There are even calculators that rank the chances of having a successful vaginal delivery after a cesarean.
Is VBAC a safe option?
Not wanting to risk pregnancy complications, women often
assume their babies must be born by c-section if they had a previous c-section.
According to the
National Institutes of Health (NIH), vaginal birth is a safe and viable
option for many post-cesarean women.
How do you know which route to take vaginal or cesarean? If your Ob/Gyn approves a VBAC, they will recommend a TOLAC trial of labor after cesarean. When labor begins, the trial begins. This simply means that you will be closely monitored and regularly assessed to confirm a safe vaginal delivery. The doctor will also be assessing whether a c-section is needed. The main reason for a repeat cesarean section after a TOLAC is failure to progress or fetal distress, not a ruptured uterine scar. However, a ruptured uterine scar is why VBAC was discouraged many decades ago.
What qualifies an appropriate candidate?
If your previous C-section incision is located horizontally across the base of the uterus, vaginal delivery may be possible. However, since the skin incision may be different than the incision on the uterus, check with your doctor to determine your type of uterine incision. Low-transverse incisions are the most common.
VBAC is also a possible option for women who have previously had two lower transverse-cesarean incisions. If you are unable to determine the type of incision, no worries. Your Ob/Gyn may still approve a vaginal delivery. Are you carrying twins? Talk to your doctor, as this does not necessarily negate you from being an appropriate candidate.
What are the benefits of VBAC?
- No surgery.
- Decreased risk of infection or excessive bleeding.
- Decreased risk of injury to internal organs.
- Decreased risk of future infertility.
- Decreased post procedural pain.
- Decreased hospital cost.
- Decreased hospital stay.
- Quicker recovery time.
What are the risks of VBAC?
If the trial of labor proves unsuccessful, with vaginal delivery being too risky, the physician will perform a c-section. During the trial, the woman will be monitored closely to ensure safety. The risks associated with VBAC are similar to the risks of any vaginal birth.
- Hemorrhage, or excessive blood loss, which requires a blood transfusion. This may occur if the uterine scar ruptures.
- Infection requiring antibiotics.
- Blood clots.
- Damage to the uterus requiring a hysterectomy, complete or partial removal of the reproductive organs.
How to proceed?
According to the CDC, VBAC is only slightly on the rise, with the most increase seen in the Hispanic community. Unfortunately, the rates of cesarean births are not significantly decreasing.
In fact, the United States has ranked as one of the top countries performing c-sections. Some physicians are not even offering VBAC to their patients who qualify. It is important to know your options and openly communicate your preferences and thoughts to your physician.
Objective criteria should be the standard of care when performing c-sections. Not all women are being given the option to deliver vaginally, regardless of research indicating better outcomes with vaginal births. For many women, a trial of labor with the hope of vaginal delivery allows them to be closely monitored and promotes decreased complications. If you have had a c-section and want to deliver vaginally, talk to your Ob/Gyn doctor.
- National Institutes of Health. What is Vaginal Birth after Cesarean?
- Centers of Disease Control and Prevention. Recent Trends in Vaginal Birth After Cesarean Delivery: United States, 2016–2018.