Considering a
VBAC (vaginal birth after cesarean)
What are the benefits of VBAC compared to a planned cesarean birth?
- Faster time to heal after birth
- Shorter hospital stay
- Less risk of infection after delivery
- No chance of problems caused by surgery (infection, injury to bowel or urinary tract, or blood loss
- Less risk that the baby will have breathing problems
- Quicker return to normal activities because there is no pain from surgery
- Greater chance of having a vaginal birth in later pregnancies
- Less risk that the baby will have breathing problems
What is my Midwives or Doctors experience with VBAC?
Jane Hedges, RM is an experienced practioner who has been offering VBAC's to women in her care for the past nine years both in Prince George and overseas. Women in our care are more likely to achieve a VBAC then those cared for my physicians. Our VBAC success rate is higher than PGRH's VBAC success rate. Choosing Midwifery care and a Doula greatly improve your chances of a successful VBAC, although we cannot promise that you will be successful you have our full support and care to achieve a safe outcome for you and your baby.
Can all women with previous cesarean birth attempt VBAC?
Some women should not try for a VBAC. If the cesarean scar is in the upper part of the uterus, where contractions occur, the risk of the uterus tearing (also called uterine rupture) is high. These women should have repeat cesarean births and avoid labour. Women with a scar in the lower part of the uterus have a lower risk of the uterus tearing and VBAC is considered safe. The type of scar you have in your skin may not be the same type of scar you have in your uterus. Your Midwife will review the records of your previous birth to find the location of your uterine scar.
What are the risks of VBAC?
- A tear or opening in the uterus (womb) occurs in 5 to 10 women out of every 1,000 low risk women who try VBAC (0.5% to 1.0%).
- Risks to the mother if there is a tear in the uterus include
- Blood loss that may need transfusion
- Damage to the uterus that may need hysterectomy (removal of the uterus)
- Damage to the bladder
- Infection
- Blood clots
- Risks to the baby if there is a tear of the uterus are brain damage and death. Not all tears in the uterus harm the baby. About 10% of the time the baby is harmed when the uterus tears. In other words, 5 to 10 babies out of every 10,000 VBAC tries will suffer brain damage or death (0.05% to 0.1%).
The normal risks of having a vaginal birth are also present for VBAC.
The risk of your uterus tearing during labour is increased with any of the following:
- Labour that is induced (does not start on its own)
- More than 1 cesarean section
- Less than 18 months since your last cesarean delivery·
- Need for medicine during labour to increase contractions·
- If a vaginal birth cannot occur, then a cesarean birth must be done.
- The rate of infection is doubled when a cesarean delivery is done after labour rather than before labour.
How can I reduce risks to my baby and me?
- Regular prenatal care is very important in reducing all risks in pregnancy.
- Having labour occur naturally, rather than using medications to start labour, brings down the risk of a tear in the uterus. Your midwife will talk to you about this, taking into account your own situation.
- Having at least 18 (24 months is better) months time between the date of your last cesarean birth and the due date of this pregnancy helps insure the strength of the uterus during this pregnancy.
What is the chance that trying a VBAC will result in a vaginal birth?
Studies suggest that 70%-80% of women who try a VBAC have a vaginal birth. There is no perfect way to say who will deliver vaginally. A number of factors increase the chance of success. However, even if none of these factors are present, the chance of vaginal delivery is at least 50%.
Factors that predict success are:
- Cesarean birth for a reason that is not likely to happen again (ie breech presentation)
- Having a vaginal birth in the past
- Labour that occurs naturally
- The length of the pregnancy is less than 40 weeks
- A cervix that is at least 2 cm dilated and very thin when admitted to the hospital
How do women make a choice about a VBAC?
Having a vaginal birth is very important to some women. For many women, the benefits of trying a vaginal birth outweigh the risks. Women who deliver vaginally have less postpartum discomfort, shorter hospital stays, and describe a feeling of wellness sooner than women recovering from cesarean section
Other women choose cesarean birth because they do not want to go through labour. They may be more concerned about the risk of the uterus tearing than the risks of cesarean birth.There may be added benefits and risks, some of them emotional, with either choice. We encourage you to discuss these issues with your provider and family.
Am I comfortable with making the decision?
Each woman’s decision is personal. Your midwife is available to guide you and your family in deciding how you have your baby. The overall goal is a healthy mother and baby, whether the delivery is by vaginal or cesarean birth.
What if I change my mind?
If during the VBAC process you have questions about continuing, we encourage you to talk with your midwife. You may change your mind about VBAC. However, if delivery is about to happen, a cesarean section may not be possible.
