Vaginal Birth After Cesarean (VBAC)
Brandy Patterson, MD
In the past, it was thought that if a woman had to delivery via cesarean section, then she could only safely proceed with repeat cesarean for all future childbearing. We now know that many women who have a cesarean (or even two) - can safely proceed with a trial for vaginal birth - called vaginal birth after cesarean (VBAC). A trial for VBAC is not the right choice for every woman with a prior cesarean, but is a very reasonable and good choice for many.
A woman certainly has the right to discuss with her obstetrician both options: repeat cesarean or the possibility of VBAC. If a trial of labor is being considered, 60-80% of those women successfully do give birth vaginally. Both VBAC and planned cesarean delivery have risks. Both can have issues with infection, injury, blood loss (hemorrhage), and other complications. With VBAC, however, the feared risk is for rupture of the uterine scar (opening of the scar during contractions of labor). This risk is very small; less than 1%. If this does occur, it can be serious and may harm both mother and baby. Therefore, it is only in specific cases where prior the prior uterine incisions is documented by reviewing the operative report of the previous cesarean section. VBAC can be considered a safe option depending on the type of uterine scar. You are a candidate if the uterine incision is described as low transverse or certain instances with a low vertical incision. In this case, the risk is truly low and certainly reasonable to consider a trial of labor.
A few reasons to consider VBAC include the absence from abdominal surgery, a much shorter and less painful recovery period, lower risk of infection, and typically less blood loss. Also, if a woman is considering a large family, VBAC and future vaginal births may alleviate risks of multiple abdominal surgeries.
Factors that directly influence a successful attempt at VBAC are: prior vaginal delivery, spontaneous labor, and cesarean sections completed for reasons of baby’s presentation (breech, transverse lie) or non-reassuring fetal status. Prior cesarean section due to failure to progress in labor has a poorer prognosis of success.
Finally, it is important to understand that many hospitals are not equipped to handle emergency situations that may arise with VBAC, and are not able to offer VBAC to their patients. The hospital must have a 24-hour guaranteed in-house Obstetrician and Anesthesiology staff in order to offer VBAC, and many hospitals are not able to offer this. At The Women’s Hospital at North Mississippi Medical Center, we are fully equipped and capable, and do offer VBAC to our patients.