What is Vaginal Birth After Cesarean (VBAC)?
If you have had a cesarean delivery (also called a C-section) before, you may be able to deliver your next baby vaginally. This is called vaginal birth after cesarean, or VBAC. Most women, whether they deliver vaginally or by C-section , don’t have serious problems from childbirth.
Is VBAC Safe?
Having a vaginal birth after having a C-section can be a safe choice for most women. Whether it is right for you depends on several things, including why you had a C-section before and how many C-sections you’ve had. You and your doctor can talk about your risk for having problems during a trial of labor.
If you and your doctor agree to try a VBAC, you will have what is called a “trial of labor after cesarean,” or TOLAC. This means that you plan to go into labor with the goal to deliver vaginally. But as in any labor, it is hard to know if a VBAC will work. You still may need a C-section. As many as 4 out of 10 women who have a trial of labor need to have a C-section.
Are You Suitable for VBAC?
According to the American College of Obstetricians and Gynecologists, you’re a good candidate for a vaginal birth after a c-section if you meet all the following criteria:
- Your previous cesarean incision was a low-transverse uterine incision (which is horizontal) rather than a vertical incision in your upper uterus (known as a “classical” incision) or T-shaped, which would put you at higher risk for uterine rupture. (Note that the type of scar on your belly may not match the one on your uterus.)
- Your pelvis seems large enough to allow your baby to pass through safely. (While there’s no way to know this for sure, your practitioner can examine your pelvis and make an educated guess.)
- You’ve never had any other extensive uterine surgery, such as a myomectomy to remove fibroids.
- You’ve never had a uterine rupture.
- You have no medical condition or obstetric problem (such as a placenta previa or a large fibroid) that would make a vaginal delivery risky.
- There’s a doctor on site who can monitor your labor and perform an emergency c-section if necessary.
- There’s an anesthesiologist, other medical personnel, and equipment available around-the-clock to handle an emergency situation for you or your baby.
What Makes You Not Suitable for VBAC?
- Being an older mom
- Being overweight
- Having a baby with a high birth weight (over 4,000 grams, about 8.8 pounds)
- Having your pregnancy go beyond 40 weeks of gestation
- Having a short time between pregnancies (18 months or less)
Benefits of VBAC
- Avoiding another scar on your uterus. This is important if you are planning on a future pregnancy. The more scars you have on your uterus, the greater the chance of problems with a later pregnancy.
- Less pain after delivery.
- Fewer days in the hospital and a shorter recovery at home.
- A lower risk of infection.
- A more active role for you and your birthing partner in the birth of your child.
Risks of VBAC
The most serious risk of a trial of labor is that a C-section scar could come open during labor. This is very rare. But when it does happen, it can be very serious for both the mother and the baby. The risk that a scar will tear open is very low during VBAC when you have just one low cesarean scar and your labor is not started with medicine. This risk is why VBAC is often only offered by hospitals that can do a rapid emergency C-section.
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