VBAC or C section: Which Should I Choose For My Second Pregnancy?

About 45% of deliveries in Singapore are Caesarian sections (C sections). That is almost one in two deliveries. If you are a C section mum and are pregnant again, one of the biggest questions on your mind is probably: VBAC or C section? This article aims to answer this in the most objective way possible.

A vaginal birth after a C Section is possible.

VBAC or C Section? 

What is VBAC?

VBAC (commonly pronounced “Vee Back”) stands for “Vaginal Birth After Caesarean”.

When you are pregnant again, your doctor will assess you if you are fit for a vaginal delivery, taking into consideration your previous medical history, the status of your pregnancy, and other factors that might complicate the delivery. 

According to the National University of Health, Singapore, you can undergo VBAC after a C Section if:

• You had only one previous Lower Segment Transverse Caesarean Section (LSCS) – that’s “doctor talk” for one regular C section.
• The reason for the previous C section is not present this time.
• The birth canal is adequate for the birth.
• There have been no other previous surgeries on the uterus (except one LSCS).
• You never had a rupture of the uterus.

Even if you pass all the criteria, your doctor will decide what is the best way to proceed with this pregnancy. Factors like adequacy of the birth canal and the general condition of the uterus play an important role in deciding on your birthing method.

Statistically speaking, if you are fit for it, VBACs are quite safe.

The risk of a rupture of the uterus is quite low. Even so, VBAC is performed only in conditions where an immediate C section can be performed.

Doctors generally opt for a C section if the labour needs to be induced. If there is any need for external intervention, the chances of complications go up. And so, it is safer to go for a C section. 

In fact, 60-80% of women who are given a trial of labour, successfully deliver vaginally. The rest may require some intervention, and so are delivered by a C section by the standby team. 

VBAC or C Section? Your doctor will help you decide

Why a Doctor Might Recommend a Subsequent C Section

C section as a delivery method has been gaining ground over the last few decades.

For most, the indications are medical, like a low-lying placenta, or an unsafe presentation. There are risks involved with it though, as with any other form of surgery. 

The reasons why your doctor would recommend a C section for your subsequent delivery are:

1. You have had more than one C section.
2. You are carrying twins or multiples.
3. The previous C section has been performed on the upper segment of the uterus.
4. The placenta is low.
5. Vaginal delivery can cause complications or is not feasible.

Doctors may give you a choice about VBAC or C section.

First and foremost, if you are a candidate for VBAC, it is safe for the baby as well as you. If your first and current pregnancies are further apart, it is better as long as you are not in the high risk of pregnancy category. 

Secondly, as the birth would be in a hospital, there should be a backup team to perform a C section in case the VBAC does not go as expected. This is, of course, like any other delivery. 

The advantages of VBAC according to the NHS UK are:

1. faster recovery
2. a greater chance of uncomplicated future deliveries
3. shorter stay in the hospital, reducing the chance of hospital-borne infections for you and the baby
4. easier breastfeeding

So, VBAC or C Section?

Whether you are hellbent on a VBAC or C Section, remember that it is not always possible to choose the way you want to deliver.

The most important thing is that both you and your baby are safe. The doctor is the best person for you to talk to, and the ultimate decision depends on many factors, like post-delivery support, financial condition, your own health and so on. 

You can always talk to your obstetrician about the pros and cons of both delivery methods, and if you feel strongly about picking one. That way, you can make an informed decision, or learn why one might be a better fit for you than the other, depending on your past medical history. 

Sources:

1. NHS, UK
2. NUH, Singapore
3. NCT, UK

Also read: Everything you wanted to know about a VBAC (Vaginal Birth After C-section)