Can I have a Vaginal Birth after a C-section?

Facts about VBAC

Many women who have had a cesarean section and are considering their options for their next delivery ask this question. Let’s look at a few statistics.

“[A]n estimated 60 to 80 percent of women who try VBAC have a successful vaginal delivery.” (MayoClinic)

“90% of women who have undergone cesarean deliveries are candidates for VBAC.” (American Pregnancy Association)

“The highest rate of VBAC involves women who have experienced both vaginal and cesarean births and given the choice, have decided to deliver vaginally.” (American Pregnancy Association)

“If you had a previous cesarean with a low transverse incision, the risk of uterine rupture in a vaginal delivery is .2 to 1.5% … approximately 1 chance in 500,” according to the American College of Obstetricians and Gynecologists. (American Pregnancy Association)

As with most things, vaginal birth after C-section (VBAC) may not be possible for all women. But if certain criteria are met, VBAC can be successful.

Advantages and Risks Associated with VBAC

Uterine rupture is the main concern with VBAC. Some studies have documented an increased rate of uterine rupture in women who have been induced. However,  there is no distinction in the increased risk for women who were induced and had a low transverse incision or those who had a classical incision.

The classical incision is a north-south incision along the midline. This cesarean technique is rarely used nowadays and generally, only in the case of an emergency section when the baby must be delivered quickly. This technique is associated with a higher risk of complications.

A lower uterine transverse incision is typically referred to as a “bikini cut”. It runs just below the bikini line and just above the pubic hair. There is less blood loss associated with this type of incision and is the method most commonly and currently used.

Indications for a VBAC include:

• Only one prior low transverse uterine scar and no other scars
• Mother and baby are healthy and pregnancy is progressing normally
• The reason for the previous C-section is not a factor in this pregnancy
• Labor begins naturally on or before your due date
• Previous vaginal delivery was successful

Contraindications for a VBAC include:

• Previous uterine rupture during a pregnancy or delivery
• Your pregnancies tend to run past the due date
• An unusually large baby
• Two or more prior C-sections and no vaginal deliveries
• Obesity
• Expecting multiples

Reasons for Repeat Cesarean

If you experience any of the conditions listed below during your pregnancy or labor (aside from the contraindications for a vaginal delivery listed above), a repeat cesarean section may be the best option for you:

• Dystocia: This is a condition characterized by a  labor that is long and difficult with slow cervical dilation, a small pelvis or a big baby (American Pregnancy Association). Sometimes the right coaching from a midwife, doula or labor coach, or a change in position and technique can make a difference in these kinds of situations. But, there is always a point in the process where the decision has to be made whether or not to refer for a C-section. It is important that your midwife knows what to look for in helping you make that decision.

• Genital Herpes:  Women with  an active genital  herpes infection run the risk of passing the active virus on to their baby as the baby passes through the vagina. A culture is taken in the weeks leading up to birth to look for any presence of the virus. If the active virus is present, then a C-section is scheduled. The American College of Obstetrician and Gynecologists states, however, that “unless there is a visible lesion at the time of birth, a vaginal birth is acceptable.” (American Pregnancy Association)

• Fetal Distress: If your baby starts to show signs of distress a C-section is probably the best option. The Centers for Disease Control and Prevention state that nearly 10 percent  of all cesarean deliveries are due to fetal distress.

It is important for you to discuss all possible options including the associated risks, potential complications and advantages before making your decision about the type of delivery you’d like to use. Of course, pregnancy and babies are not always predictable and a planned VBAC may indeed turn into a need for a repeat cesarean. It is  important to expect the unexpected and make the best decision possible for you and your baby.

Darlene Oakley is a freelance writer for EmpowHER.com.

Sources:

VBAC (vaginal birth after C-section). MayoClinic. Web. May 1, 2012.

http://www.mayoclinic.com/health/vbac/MY01143

VBAC: Vaginal Birth after Cesarean. American Pregnancy Association. Web. May 1, 2012.

http://www.americanpregnancy.org/labornbirth/vbac.html

Caesarean section. Wikipedia. Web. May 1, 2012.

http://en.wikipedia.org/wiki/Caesarean_section