Vaginal Birth After A Cesarean Section

It used to be that once you had a cesarean section, you always had to deliver your children in that fashion. Nowadays, many women are able to choose between having a repeat c-section and delivering vaginally after a cesarean.

What is VBAC?
Vaginal Birth After Cesarean is what VBAC stands for. It is a vaginal birth after one or more cesareans. More than 80% of women will be able to have a VBAC. VBAC is safer than repeat cesarean and VBAC with more than one previous cesarean does not pose any increased risk.

Tips for a Healthy Vaginal Birth

Use these tips to help ensure your VBAC goes well.
  • Get in training. Labor is the hardest work you'll ever do, but it's worth it! Focus on good nutrition and exercise

  • Make a daily checklist to ensure you are getting essential nutrients

  • Exercise daily: swim, walk, yoga, prenatal fitness class -- whatever feels good. Plus, being in good physical health will help make your labor easier and possibly shorten your healing time afterwards.

  • Take prenatal classes. Be sure to register early for a VBAC, refresher or any other quality prenatal program. Even though you may have taken classes in a previous pregnancy, an evening out together with your partner will help to prepare you both, promote discussion, give you ideas on coping with labor and focus on this baby and its birth.

  • Look for a supportive care provider. Find someone who believes in VBACs, has a VBAC success rate over 75% and a cesarean rate that is lower than the community average. If you are unsure about anything, get a second opinion.

  • Get as much information as you can. Obtain a copy of your medical records from the previous birth(s) for yourself. Ask your current care provider to explain anything that you don't understand. Talk to your care provider, make plans with them. Talk to other people who have been there. Read a lot of books and journals.

    More VBAC Tips

  • Establish a safe supportive birth environment to facilitate labor
  • Try a variety of positions. Standing or walking instead of lying down facilitates labor while squatting to push can be more effective.
  • Continue eating and drinking. Labor is hard work and takes a lot of energy. Far from eliminating the risk of aspiration with general anesthesia, total fasting may increase the risk by raising the acidity of the stomach contents. Fasting may also make it harder for the uterus to work.
  • Learn to trust, cooperate with and listen to your body and your own unique labor pattern.
  • Reassure family and friends. Remember that, according to medical studies, VBAC is usually safer for both you and your baby than a repeat cesarean.
  • Attend VBAC support meetings or, if there are none in your area, join national organizations. Through meetings and newsletters you'll hear from others who've "been there" and will share their VBAC experiences.

    Why Would I Want a VBAC?
    Every woman has a different reason for wanting a vaginal birth after a cesarean. For some, the justification may be medical and while other women feel an emotional need to give birth vaginally. For others still, the cause may be financial or in terms of recovery.

    There are numerous benefits of a vaginal birth. For mothers, these benefits include:

    • Reduced risk of maternal death
    • Fewer complications
    • Prevention of blood loss, infection, blood clots in legs and injury (bowel, urinary tract, etc.)
    • Breastfeeding is generally easier after a vaginal birth
    • The cost of a vaginal birth is about $3,000 less
    Your baby also benefits from a vaginal birth:
    • Prevention of Iatrogenic Prematurity (meaning surgery was done because of an error in guessing a due date)
    • Reduced chance of Persistent Pulmonary Hypertension
    • Prevention of surgery related fetal injuries (lacerations, broken bones)
    • VBAC results in fewer fetal deaths than elective repeat cesareans
    Risks of VBAC
    A common fear among women who have had a previous cesarean is rupturing of the uterus. Most of this fear dates back to when the incisions of the original cesarean were of the classical variety (vertical incisions). There are two types of uterine rupture: complete and incomplete.

    Complete uterine rupture is very unlikely today for a variety of reasons. First, if pitocin is used during labor, the amount is regulated. Previously, it was administered through IV to a woman and allowed to flow freely. Secondly, because of the rarity of vertical incisions, the number of ruptures has lowered. Nowadays, most incisions are the low transverse type, which means the incision is made across the lower part of the uterus. A complete rupture occurs in less than 1% of women attempting VBAC.

    Incomplete rupture occurs about 1-2% of the time. However, usually these women are asymptomatic, and neither mother nor infant require any assistance.

    Am I a Candidate for VBAC?
    Whether or not you will be able to try VBAC will depend on several things. These include:

    • Low transverse incisions on both the abdomen and uterus from previous cesarean. If you had a low-transverse uterine incision, as 95 percent of women do today, your chances of having a VBAC are good. However, if you had a classic vertical incision down the middle of your uterus, you will probably not be allowed to attempt a vaginal delivery because of the possible risk of rupture of your uterus.
    • Adequate pelvis
    • Reason for previous cesarean. If the reason that you had the previous cesarean was something that is not likely to repeat during this pregnancy, such as infection, drug or alcohol abuse, preeclampsia etc., you are a good candidate for VBAC. If, however, the reason for your cesarean was a chronic illness that is likely to impact your current pregnancy, such as high blood pressure or diabetes, you will probably require a repeat cesarean.
    • Willingness to prepare for VBAC

    Every woman has a different reason for wanting (or not wanting) a VBAC birth. Want to share your story about VBAC to help other women in their decision? Then visit Pregnancy Stories to post your experience with VBAC.

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