Vaginal birth after cesarean
Regardless of how you birthed, or how you plan to birth, if you believe that every pregnant person should have access to vaginal birth after cesarian, you’re in the right place!
What is a VBAC?
VBAC is a vaginal birth after a caesarian. It means having your baby vaginally when you’ve had at least one baby by caesarian section, also called a c-section. The success rate for VBAC is very good as long as you’re tested to be the right patient for a vaginal birth after a cesarian. Of course, your chances of success are higher if the reason for your previous c-section isn’t likely to be an issue this time around. It is not possible to predict as to which patient might have a successful VBAC and which patient will end up with a c-section again. Attempting a VBAC is called a trial of labour after cesarian (TOLAC). Overall, about 60 to 80 percent of women who attempt a VBAC deliver vaginally. Some of the important definitions on vaginal birth after cesarian (VBAC) delivery are:
- A trial of labour after cesarian (TOLAC) is an attempt to labour and have vaginal delivery by a woman who had previously undergone a C-section delivery.
- A VBAC is defined as a “successful” trial of labour resulting in a vaginal birth after a C-section delivery.
- A TOLAC may end up in either a “successful” VBAC or a “failed” trial of labour and then result in a repeat cesarian delivery.
- A repeat cesarian delivery (RCD) may be planned and scheduled beforehand and thus is an elective repeat cesarian delivery (ERCD).
Benefits of VBAC
The benefits of a trial of labour after cesarian (TOLAC) resulting in a vaginal birth after cesarian (VBAC) include the following:
- With a successful VBAC, you can avoid a major abdominal surgery and all the risks associated with it.
- Shorter length of hospital stay and postpartum recovery (in most cases)
- Fewer complications, such as postpartum fever, wound or uterine infection, thromboembolism (blood clots in the leg or lung), need for blood transfusion
- Fewer neonatal breathing problems
Risks of VBAC
- About 20-40% of women who attempt for VBAC, a failed trial of labour after cesarian (TOLAC) without a vaginal birth after cesarian (VBAC) happens and this results in a repeat cesarian delivery (RCD).
- There is a risk of uterine rupture, and this results in an emergency C-section delivery. This uterine rupture may be related to the type of uterine incision that was made during the first cesarian delivery. A previous transverse uterine incision has the lowest risk of rupture (0.2 to 1.5 percent risk). Vertical or T-shaped uterine incisions have a higher risk of uterine rupture (4 to 9 percent risk). The point to remember is that the direction of the skin incision done does not indicate the type of the uterine incision that was made. A woman with a transversal skin incision may have had a vertical uterine incision.
- While women who attempt TOLAC and VBAC have a low risk of uterine rupture, the risk of uterine rupture is higher with VBAC than with RCD.
- If your attempt to deliver vaginally fails, you would have to go through hours of labour only to have an unplanned c-section.
- A successful VBAC is less risky than a scheduled repeat c-section, an unsuccessful VBAC requiring a c-section after the onset of labour carries more risk than a scheduled c-section.
- In VBAC and with elective repeat cesarian delivery (ERCD), the risk of fetal death is very low. However, when compared with ERCD, the likelihood of fetal death is higher with VBAC. Maternal death is very rare with either type of delivery.
- There is the risk of the baby having a serious complication that could lead to long-term neurological damage.
Who should attempt VBAC?
- The trial of labour after cesarian or TOLAC and the choice to attempt a vaginal birth after cesarian (VBAC) is an option only for a woman who has undergone one prior C-section delivery with a low transverse uterine incision, assuming there are no other conditions that would normally require a cesarian delivery/
- In cases where a woman with a twin pregnancy, or a woman with two prior low transverse uterine incisions, or a woman who requires induction of labour may also be considered candidates for VBAC with appropriate counselling.
- TOLAC with anticipated VBAC should be attempted only in those facilities capable of performing emergency cesarian deliveries.
- One should discuss with her doctor all the risks and benefits of VBAC versus the risks and benefits an elective repeat cesarian delivery (ERCD) before considering VBAC. The discussion should also include plans for intervention in the case of uterine rupture or another indication for an emergency cesarian delivery.
Management during labour
A woman who attempts VBAC is taken care in the same way as women anticipating a vaginal delivery. A fetal monitor may be used to observe the baby’s heart rate and monitor for early signs of fetal distress. Medications to induce labour or improve contractions and medications for pain relief are used cautiously since they can increase the risk of uterine rupture.