VBAC (Vaginal Birth after C-section)
VBAC, or vaginal delivery after C-section, describes a situation when a woman has a vaginal delivery after having a previous cesarean section.
Nationally, about 25% (1/4) of all chlidren are born following a c-section. 60-80% of women who have previously undergone c-section can safely give birth vaginally.
The American College of Obstetricians and Gynecologists (ACOG) stated that VBAC is safer than repeat cesarean and VBAC with more than one previous cesarean does not pose any additional risk.
There is no evidence that a big baby requires a c-section. The pelvis and the baby's head are not rigid structures and both mold and change shape to allow for birth. During labor there are certain positions that a woman can use to help open up the pelvis, allowing a larger baby to move through.
Risks of VBAC
The greatest risk for women who have had a previous c-section is the risk of a uterine rupture during a vaginal birth. According to ACOG, a woman who has had previous c-section with a low transverse incision (as opposed to other approaches), has a low risk of uterine rupture during vaginal delivery of .2 to 1.5%.
In the past, women with a history of genital herpes were often directed to have a c-section due to the risk of passing herpes to the baby during delivery. Doctors would perform a viral culture in the last few weeks of pregnancy and a c-section would be performed if the tests showed the presence of the herpes virus. Now ACOG has determined that unless there is a visible lesion at the time of birth, a vaginal birth can be performed without significant greater risk.
VBAC may be considered in the following cases:
- The woman has had no more than 2 low transverse c-sections.
- There are no additional uterine scars, anomalies or previous uterine ruptures.
- The VBAC is performed where there is easy access to the resources for a c-section, if necessary.
- Fetal heart rate monitoring and other care is available.
VBAC is a particularly safe option in the following circumstances:
- the medical reason for the previous c-section is not present during the present pregnancy
- the woman has no major medical problems
- the baby is a normal size
- the baby is head-down (not breech)
VBAC is generally not recommended in the following circumstances:
- a woman who is pregnant with twins
- a woman who has diabetes
- a woman high-blood pressure
Talking with Your Doctor
If you are interested in trying VBAC, ask your doctor if you are a good candidate. A key factor in this decision is the type of incision made to your uterus with previous c-sections.
Choosing to try a VBAC is complex. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your choice.
Reference: U.S. Department of Health and Human Services