I met my firstborn in a dramatic emergency C-section that left me dreading the thought of producing another child. Although I had always wanted a large family, I had been told that having one C-section meant that any future children would have to be born the same way—and after extended hospitalization and complications, I wasn’t convinced I could go through the physical recovery from a repeat C-section again.
However, several years and a great deal of convincing later, I became pregnant with my second child and begged my OB/GYN for another option to avoid a repeat C-section. It was then that she enlightened me about the process of vaginal birth after Cesarean, commonly known as a VBAC.
What is a VBAC (Vaginal Birth After C-Section)?
A vaginal birth after C-section (VBAC) is an effort to give birth vaginally when a previous baby was delivered via C-section. If a woman chooses to try a vaginal delivery when she has had a previous C-section, she will undergo a trial of labor—an attempt to go through the stages of labor and deliver vaginally. It’s called a trial because usually, you will be monitored more closely to avoid any complications that you’re at higher risk for due to your history with C-section.
What are the Benefits of a VBAC?
Women may choose a VBAC for a variety of reasons. Some wish to avoid the surgical recovery that accompanies a C-section. Others may wish to have a VBAC in order to experience vaginal birth. The American College of Obstetricians and Gynecologists associates VBAC with fewer risks of complications in future pregnancies, making this method of delivery also appealing to women who wish to birth multiple children.
Dr. Daniel Roshan, a top board-certified, high-risk maternal-fetal OBGYN in New York City, advocates VBAC delivery over C-section whenever possible. “The C-section is a major surgery,” he cautions. “It’s associated with more pain in delivery and after birth and carries a risk in subsequent pregnancies.” Dr. Roshan cites bladder and bowel injuries as additional potential hazards with subsequent C-sections.
In addition to avoiding the surgical risks and pain in recovery from a C-section, I personally sought a VBAC in order to have more involvement in my baby’s delivery. After complications in the delivery room the first time around, I simply wanted to feel more connected to my second baby’s birth. I made the attempt to VBAC in order to be more present, mobile, and alert during my baby’s first few days.
What are the Risks of VBAC?
While vaginal birth after C -section is an appealing option for many women, there are serious risks associated with this method of delivery. Complications such as blood loss and infection can occur in women who attempt to VBAC.
Uterine rupture—a rare but serious circumstance in which a woman’s C-section scar tears open—may be dangerous to both mother and baby during a VBAC attempt. Dr. Roshan explains that the rupture of the uterus can cause hemorrhage and “can lead to fetal neurological damage.”
The ACOG suggests that some uterine incisions are more susceptible to tears than others, with low transverse incisions (the most common type performed with C-sections) carrying the lowest level of risk. It is critical to discuss your previous delivery via C-section with your current OB/GYN in order to properly weigh your level of risk with a VBAC.
How to Attempt a VBAC
If you’ve had a previous Cesarean delivery and are considering VBAC, you should maintain an open conversation with your OB/GYN. Your personal medical history and goals will play a large role in the decision to VBAC, so it’s important to convey your wishes to your doctor and ask them to walk you through the risks and benefits for both you and your baby. Choosing a hospital that is VBAC-friendly can be helpful as well.
It’s also important to consider that not everyone is a good candidate for VBAC. “It’s the role of the doctors to decide which patients are good candidates,” says Dr. Roshan. “Sometimes we don’t want to waste your time or our time or cause complications.”
To make decisions regarding methods of delivery, professionals at Dr. Roshan’s practice observe the size of the baby, fetal position, the mother’s weight, pelvis, delivery history, and other parameters to make decisions about whether or not a patient is a good candidate for VBAC. Because of the many factors involved in the decision to attempt a VBAC, transparent communication with medical providers is key.
What Can Help Your Chances of a Successful VBAC
There are many different factors that will determine if you are able to deliver vaginally after a C-section, and most of them are completely out of your control. It’s also important to remember that even if try to have a VBAC and you and your healthcare team ultimately decide a C-section is best for you and your baby—that’s still success! There is no “right” way to give birth.
That being said, if you are planning for a VBAC and are wondering if there is anything you can do to prepare, Dr. Roshan does offer the following advice:
- Maintain a healthy weight as much as possible. Dr. Roshan has recently conducted a study in his practice linking diet and exercise to successful VBACs. “The majority of C-sections are done because of the size of the baby; the baby is too big and the labor doesn’t progress,” he says. “The mother’s weight and diet could be the mother of a lot of problems, for both the mothers and the delivering doctors.”
- Incorporate exercise into your daily routine. To that finding, Dr. Roshan advocates mothers maintain a diet and exercise routine during pregnancy. “Diet and activity is in your control,” Dr. Roshan says of women who wish to attempt a vaginal birth. He advises safe exercises such as walking, jogging, and swimming in conjunction with a healthy diet to raise a mother’s chances for a successful VBAC.
- Consider some labor prep. When you’re full-term (over 37 weeks) and only if you have cleared it with your own doctor, Dr. Roshan says that evening primrose oil and red raspberry tea can support the softening of the cervix and improve the chances of entering labor naturally and dilate quicker. “These can help some patients to soften the cervix prior to labor and have a more successful chance of progressing to full dilation and vaginal delivery,” he explains.
As your due date nears, it’s also important that you keep in mind that your circumstances may change as well. I attempted a VBAC in two pregnancies after my first emergency C-section. In both, I developed complications that led to repeat Cesareans.
After all of my research and preparation, I admit that it was disheartening to not meet my delivery goals for VBAC. However, because I had established open communication with my doctors, I found that both of my subsequent deliveries were more peaceful and positive. Empowering yourself with knowledge and keeping an open dialogue with your doctor will help you make the best possible decisions as you prepare to meet your baby—no matter how they enter the world.
Frequently Asked Questions
Can you get an epidural with VBAC?
Women who opt for VBAC have access to the same pain relief options as any woman who labors with a goal to deliver naturally.
How do I know if I’m a good candidate for a VBAC?
You should discuss with your doctor whether or not you are a good candidate for VBAC. Reviewing your medical history, family goals, and current pregnancy needs will help you and your doctor make the best decision for you and your baby.
Does a VBAC hurt more than a C-section?
Every labor is different, and every woman has a different threshold for pain. The recovery process for VBAC is generally shorter than C-section recovery, so women who VBAC may need fewer pain management options after delivery.
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Reviewed by Chaunie Brusie, RN, BSN…