Everything You Wanted To Know About A VBAC (Vaginal Birth After C-section)

Did you previously have a C-section to deliver your baby, but then this time around you are hoping to deliver your next baby naturally? There’s still a chance for a vaginal birth after a C-section (VBAC).

But first, you need to know whether your doctor will give you the green light after carefully assessing your pregnancy and considering your medical history.

It is also crucial that you learn about the risks involved when opting for a VBAC and how you should prepare yourself for one.

What Is VBAC in Pregnancy

VBAC stands for “vaginal birth after cesarean.” It refers to a mother’s ability to deliver her baby vaginally after having had a previous cesarean delivery.

Cesarean delivery is a surgical procedure in which the baby is removed from the uterus through an incision in the abdominal wall and uterus. It is typically performed when complications arise during labour or when there are risks associated with vaginal delivery.

The number of women choosing to have VBACs has been rising recently. While some doctors may oppose VBACs because they believe that the risks of uterine rupture, haemorrhage, and infection are too significant, many doctors support VBACs because they feel that women should be allowed to try for a vaginal delivery if they want one.

Is Vaginal Birth After Caesarean (VBAC) Safe For Your Baby

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Most mums ask, “Is VBAC safer than repeat cesarean?”

Vaginal birth after cesarean is generally safe for you and your baby. Most women who have VBAC experience no complications. Compared to a planned repeat cesarean delivery, there is a lower risk of haemorrhage (bleeding), infection, blood clots, and injury to the uterus during labour.

Is VBAC Delivery Safe For the Mum

VBACs are considered safe for both the mother and the baby. There are several reasons why a woman might choose VBAC over repeat caesarean section. These include wanting to avoid major surgery, she wants to avoid maternal mortality and fetal death or neonatal death and/or morbidity.

There are also many reasons why women choose repeat caesarean section over VBAC, including:

• the risk of uterine rupture during labour or delivery
• the need for an emergency repeat c-section
• concern about incontinence after VBAC
• concern about urinary incontinence after VBAC
• concern about bowel dysfunction after VBAC
• concern about sexual dysfunction after VBAC.

It is important that women considering VBAC discuss their options with their doctor and make an informed decision about what’s best for them and their baby.

How Does It Work?

During pregnancy, your body undergoes changes that allow it to prepare for labour and delivery. During labour, your cervix softens and opens up to allow your baby through into the world. 

In a VBAC delivery, you’ll use these same muscles to push out your baby. The only difference is that they’ve already been stretched before. They’re more likely to tear or be injured during labour again.

What Are the Benefits of VBAC Birth Plan

A VBAC can be an exciting experience for both mother and baby as there are many benefits associated with VBACs. These include:

• A shorter labour time and recovery period
• There is less blood loss during delivery
• Lesser chance of infection or rupture of membranes (amniotic sac) during labour
• Less chance of needing an epidural or general anaesthesia during labour
• Lower risk of postpartum depression due to lower levels of anxiety during labour

Crying newborn

Criteria to get a VBAC

Just because you previously had a C-section, this does not mean that you will automatically have to deliver your next baby that way too.

According to the KK Women’s and Children’s Hospital (KKH), pregnant mums who previously have had one uncomplicated lower segment C-section (LSCS) and no other medical issues in the current pregnancy are suitable candidates for VBAC.

Factors that will help you have a successful VBAC include:

• No more than two low transverse C-section deliveries
• No additional uterine scars, anomalies or previous ruptures
• Your doctor should also prepare to monitor your labour and perform (or refer for) a C-section if needed
• If the original reason for your previous C-section delivery is not repeated with this current pregnancy
• You have no major medical problems or health issues
• Your baby is not larger than average
• Your baby is head-down (or engaged)
• You have had a vaginal birth before
• Your labour starts spontaneously

Factors that will affect your chances of having a successful VBAC are:

• Being an older mum
• You are overweight or obese
• Your baby has a high birth weight (the average birth weight for babies in Singapore is 3.2kg)
• Your pregnancy has gone beyond 40 weeks of gestation
• There is a short time between your pregnancies (18 months or less)
• The reason for your previous C-section delivery was due to Dystocia

Remember to talk with your doctor about your chance of success and critically weigh out all the benefits and risks of a VBAC before moving forward.

If you had a large baby, it could have been one of the reasons for your previous C-section delivery

Can Labour be Induced with VBAC

Induction of labour can influence the success of VBAC, but its effect can vary depending on multiple factors, such as the reason for the previous caesarean section, the type of incision, and the specific circumstances of the current pregnancy.

In some cases, induction might be associated with a slightly lower success rate of VBAC, as induction procedures could potentially increase the risk of complications or affect the progress of labour. However, there isn’t a one-size-fits-all answer, as outcomes can differ among individuals.

It’s important to note that the decision to induce labour should be carefully considered by healthcare professionals in collaboration with the expectant mother. They will take into account various factors, including the woman’s medical history, the reason for the previous caesarean section, and the current condition of the mother and baby.

VBAC vs Repeat C-section

According to KKH, the chance of a successful VBAC is around 60 to 70 per cent and is generally higher for women who have had previous successful vaginal deliveries before.

However, the chances may be lower if the previous C-section was due to Cephalopelvic Disproportion (CPD) when the baby is too big to pass through the pelvis.

(According to the American Pregnancy Association)What are the risks?

If you are considering getting a VBAC, there are a few potential serious risks involved that you should make yourself aware of, such as:

A failed attempt at labour

It is perilous if you have to deliver your baby via an emergency C-section after a failed VBAC — the reasons for this can be due to your labour not progressing or if there is evidence of foetal distress.

Uterine rupture

Although this is rare, your uterus might tear open along your old scar line from the prior C-section.

If this happens, an emergency C-section helps prevent any life-threatening complications such as heavy bleeding or you getting an infection; and possibly even brain damage for your baby.

In some cases, a hysterectomy might have to be performed (to remove your uterus) to stop the bleeding — therefore, you will not be able to get pregnant again.

Foetal distress

Foetal heart rate monitoring will help to detect any signs of foetal distress and is usually a routine part of the VBAC procedure.

If your baby’s life is at risk from foetal distress or other complications, you will have to consider getting a C-section delivery instead.

Dystocia

Dystocia is when you have long and difficult labour due to slow cervical dilation, if your baby is too large for the pelvic opening, or if your baby is in an abnormal position.

If detected early with such complications your OB might advise you to opt for a C-section instead of a VBAC.

Genital herpes

Mums with a history of herpes will be strongly encouraged to deliver by C-section because of the risk of passing herpes to your baby during delivery.

Tests examine the cultures during your last weeks of pregnancy, and if they find an active virus, then that calls for a C-section to be scheduled.

Perineal tears

During vaginal birth, the pressure from your baby’s head pushing through can cause tears and lacerations in your perineum (that sensitive area between your vagina and your anus) and possibly your cervix.

All women delivering vaginally are at risk of getting a small tear, and you should also expect some perineal postpartum pain.

ALSO READ:

Pregnant Mums, Here’s How to Increase Your Chances of Having a Normal Delivery

Expert Speak: Having A Normal Delivery Post A Cesarean Is Highly Risky

Gentle C-Section: Weighing the Pros and Cons

Preparing for your VBAC

• Learn more about VBAC by taking a childbirth education class. Specifically on VBAC. Read up about it, and discuss it in more detail with your doctor
• Ensure your doctor has your complete medical history. This includes the records of your previous C-section and any other uterine procedures or surgeries.
• Talk to other mums who have experienced a VBAC before to get their first-hand accounts.
• Choose a well-equipped hospital to deliver your baby. Somewhere equipped to handle an emergency C-section (should you require one)
• If possible, allow your labour process to begin naturally, as drugs that are used to induce labour can make contractions stronger and more frequent, which might increase the risk of a uterine rupture
• Prepare yourself for a C-section if complications arise during your pregnancy or the delivery.

Image Source: iStock

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