Vaginal birth after cesarean

If you are pregnant and have previously delivered a child via cesarean section, you might think another C-section is the only choice for you. But that’s not necessarily true.

According to the American Congress of Obstetricians and Gynecologists, vaginal birth after cesarean, or VBAC, is a reasonable choice for most women – even those carrying twins – if the delivery occurs in a hospital equipped to handle emergencies if they arise. In fact, women who try to give birth vaginally after having a C-section are 60 to 80 percent successful, according to research released in 2017.

VBAC is a popular topic because of how many C-sections are performed in the United States every year. Data from 2015 shows that 32 percent of deliveries – 1.2 million -- were by C-section.

The American Congress of Obstetricians and Gynecologists issued guidelines supporting VBAC in 2010, and the group issued updated guidance in 2017 that VBAC “should be attempted” at facilities that also perform emergency deliveries.

Advantages of VBAC

A VBAC avoids major abdominal surgery, lowers a woman’s risk of hemorrhage and infection, and shortens postpartum recovery.

It might also help women avoid future risks of hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal attachments of the placenta that increase with multiple cesarean sections.

Risk of VBAC

VBAC carries the risk of uterine rupture. Although rare, a uterine rupture can be a life-threatening emergency for both you and your baby.

Regarding your previous C-section, a side-to-side cut on the lower part of the uterus stands the least chance of rupturing, while an up-and-down cut on the upper part of the uterus carries the highest risk of rupturing.

It’s important to note that you can’t tell what kind of cut was made in the uterus by looking at the scar. Your medical records from the previous delivery, which should include the location of the incision, should be given to your current OB-GYN.

After uterine rupture, an immediate C-section is required in order to minimize the risks to the mother and baby.

Who should have VBAC?

Most women who can give birth in a hospital that can provide immediate emergency care are good candidates for VBAC.

“We have been doing vaginal births after cesarean for a long time at UK HealthCare. We are able to offer them because of the resources we have,” said Dr. Wendy Hansen, head of UK Women’s Health Obstetrics & Gynecology.

“One of the guidelines requires that a team be available for immediate response in the case of emergency. We have a team of doctors on site – residents and attending faculty members – in labor and delivery, 24 hours a day, every day of the year. There is never a time we do not have a dedicated attending physician, residents, fellows and anesthesiologist ready to respond very quickly should the need arise.”

The bottom line? If you’ve previously delivered via C-section, talk to your doctor about whether you are a candidate for VBAC.