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Sharp Health News

VBACs: what you need to know

Aug. 20, 2015

VBACs after C-sections

If you have delivered a baby by cesarean section, also known as a C-section, and are curious whether vaginal birth for the upcoming arrival of another little bundle of joy is possible, you'll be happy to know mothers are now allowed more freedom of choice in their deliveries.

In fact, vaginal births after cesareans, or VBACs, are becoming more common, and 60 to 80 percent of women who attempt a VBAC have a successful vaginal delivery.

In order to determine if you are a candidate for VBAC, it is important that you discuss this option with your doctor. After reviewing your medical records, obstetrics history, personal risk factors and your current pregnancy complications, you and your doctor can decide whether VBAC is right for you.

"After considering the benefits versus the risks of a repeat C-section compared to a vaginal birth, you may decide VBAC is an option you want to explore," says Dr. Colleen McNally, an OBGYN and chief medical officer at Sharp Mary Birch Hospital for Women & Newborns.

"Of course, not every woman who has had a C-section wants a VBAC, and that's OK. And not every woman who has had a C-section is a candidate for VBAC, which is also OK. There are a variety of factors to consider when planning your next delivery."

To help you as you ponder the possibility of VBAC, Dr. McNally answers a few frequently asked questions.

Why should I consider a VBAC?

There are various benefits associated with a VBAC, including:

  • Lower risk of infection
  • Avoiding another incision in the uterus (important if considering future pregnancies)
  • A more active role in the delivery for you and your birthing partner
  • Less pain post-delivery
  • Ability to breastfeed sooner after a vaginal birth
  • Shorter hospital stay and recovery time

What are the risks?

Vaginal birth after C-section carries little risk for mother and baby, provided it is appropriate and successful. However, there are risks involved with attempting VBAC, such as:

  • An unsuccessful labor that ends with a C-section — Up to 28 percent of women who attempt VBAC develop a problem that requires a C-section, which increases the risk of infection for both the mother and baby.
  • A slight risk of uterine rupture (7 out of 1,000), which can be life-threatening for the mother and the baby. If the rupture cannot be repaired quickly, removal of the uterus (hysterectomy) may be necessary to prevent severe blood loss; there is a risk of brain injury to the infant. Although it is not possible to predict that a woman will have a uterine rupture, there are known risk factors that can be identified:
    - Interval of less than 18 months between pregnancies
    - Mother who is obese
    - Previous classical or vertical uterine incision or single-layer closure
    - Certain types of labor induction
    - History of two or more previous C-sections

How do I know if I am eligible for a VBAC?

VBAC eligibility depends on many factors, including:

  • The reason for the prior C-section — If the baby was breech or distressed, you may be a good candidate for VBAC. If the baby didn't fit through your pelvis, or your cervix didn't dilate, the odds of a successful VBAC may not be as high.
  • The type of uterine incision that was used for your prior C-section and whether it was closed in one or two layers — a low transverse incision is the strongest and least likely to open during labor.
  • Whether you have a history of previous uterine rupture or uterine surgery.

How can I best prepare for a VBAC?

The most important thing when seeking a VBAC is ensuring that everyone around you is supportive of your choice. This means finding a provider and a hospital or birth center that allows and is truly supportive of VBAC. Anyone present with you during your labor should be supportive of your choice as well.

If you decide you want to try for a VBAC, ask your doctor about his or her VBAC outcomes. If you are working with a provider group, ask the same questions about the group as a whole since your own doctor may not be the one to attend your birth.

It's also important to keep in mind that some hospitals don't allow VBACs. Anesthesia must be available at all times in case a C-section becomes necessary, and not all hospitals can afford this luxury. Talk to your health care provider early in your pregnancy to make sure VBACs are allowed where he or she does deliveries.

Finally, it is important to understand that conditions may arise during pregnancy or labor that can make it unsafe to attempt a vaginal delivery after C-section. The health of you and your baby is the most important factor for the doctor caring for you.

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