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Mary M. Murry, R.N., C.N.M.
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Mary M. Murry, R.N., C.N.M.
Mary M. Murry, R.N., C.N.M.
Mary Murry is a certified nurse-midwife in the Department of Obstetrics & Gynecology at Mayo Clinic, Rochester, Minn.
Murry, a Cincinnati native, has been a nurse-midwife practitioner for more than 20 years and is an instructor at the College of Medicine, Mayo Clinic. She was a contributing reviewer and writer of the "Mayo Clinic Guide to a Healthy Pregnancy" book.
Her research interests include adult female survivors of sexual abuse, women's perception of pain in labor, and obesity in pregnancy.
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Pregnancy and you blog
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Feb. 19, 2010
To VBAC or not to VBAC?
By Mary M. Murry, R.N., C.N.M.
To VBAC or not to VBAC, that is the question. A little misquote of Hamlet here, but the decision about whether to pursue a vaginal birth after C-section (VBAC) can be a weighty one. If you're considering VBAC, ask yourself these questions:
Is VBAC safe for you — and for the baby? VBAC eligibility depends on many factors, including the type of uterine incision that was used for your prior C-section. A low transverse incision (think bikini scar on your uterus) is strongest and least likely to open during another labor. If you aren't sure what type of uterine incision was used, check the operative report from your prior C-section.
The reason for the prior C-section also matters. If the baby was breech or distressed, you may be a good candidate for VBAC. If the baby didn't fit through your pelvis or your cervix didn't dilate, the odds of a successful VBAC may not be as high. Don't take this as an absolute, though. Every baby is different, and every labor is different. I participated in a VBAC for a woman who had a prior C-section because the baby wouldn't fit through her pelvis. The baby I delivered vaginally weighed 2 pounds more and fit just fine!
It's also important to keep in mind that some hospitals don't allow VBACs. Anesthesia must be available at all times in case a C-section becomes necessary, and not all hospitals can afford this luxury. Talk to your health care provider early in your pregnancy to make sure VBACs are allowed where he or she does deliveries. If not, you may need to change providers or hospitals if you want to pursue VBAC.
How strongly do you want a vaginal birth? If you felt cheated out of a vaginal birth after your C-section, you may want another chance — especially if you think you could have delivered the baby vaginally if you'd been given more time. Remember, your feelings are important. Don't discount them. Instead, give your feelings as much weight as any other factor.
Of course, not every woman who's had a C-section wants a VBAC — and that's OK. If you're unsure about VBAC, trust yourself to decide what's best in your case. As long as your health care provider agrees that VBAC is a safe option, I personally believe that you can't make a wrong decision.
35 comments posted
April 25, 2010 6:02 p.m.
I had a successful VBAC few days back and I am so happy I tried it... I felt cheated with my 1st one and felt I wasn't given enough time to try it normally. I changed my doctors and my present doc was supportive of VBAC from the very beginning. And with the support of my doctor and hospital and my loved ones I was able to deliver my second bundle of joy normally. I feel if you are strong candidate of VBAC and you want to try it just go for it. Good Luck ...
- VBAC@supporter
April 23, 2010 8:50 a.m.
Viki, a VBAC is a vaginal birth after C-section. VBAC might be a possibility for a woman who's given birth by C-section but hopes to experience a vaginal delivery with a subsequent pregnancy.
- Editor@Mayo
April 22, 2010 10:14 p.m.
What is a VBAC????!! I've seen it a lot and NO ONE defines it!! Even at the beginning of this article you act as though everyone knows what VBAC is. They don't. I still don't!
- Viki
April 12, 2010 11:05 p.m.
Mary, I had to read this twice to parse what folks were seeing... and then got it. People are reading what you wrote as "VBAC is a luxury..." when what you're saying is "Hospitals require an anesthetist be available for a VBAC and the anesthetist is seen as a luxury they can't afford." Might help to slightly revise the OP to this effect. But I do agree, wholeheartedly, that if a hospital refuses VBACs on the basis that they are not adequately staffed to handle an emergency, then they should also be refusing all primary births and even a healthy dose of VBAVBs because, heaven forbid, they might result in an emergency as well. And as for fighting the fight, mad props to those who do. I know, from fighting interventions during my second birth, that it's not easy to stand up to medical professionals who believe that because they learned it that way, it _must_ be how it's done. I know not all--and I believe not even most--medical professionals are like this, but one experience can sour a person, ya know?
- Moshermama
March 22, 2010 1:05 p.m.
I believe that women are able to make their own decisions about their lives and health. I had an anesthesia provider ask me once why didn't I just tell the woman that she needed a c.section. My reply to her was that it wasn't my decision. My responsibility was to give her all the information available, answer any questions and let her know my recommendations. The patient would decide after that. The word luxury may not have been a word that you would associate with whether or not your have a VBAC. I'm afraid in our current health care culture it could get to be that. No one can force a woman into surgery she does not want. To my way of thinking, if possible the birth experience shouldn't have to be a battle. Find out early in pregnancy if VBAC if offered in your area. You may have to go outside your local area. If there are no options available then you will have to fight the fight to make it happen. Have all your information, have plenty of support with you, sign forms. Do what needs to be done. If it weren't for womens voices and fighting the system more than 30 years ago, natural childbirth would still be "odd". I've been in OB long enough to know that we women have power and we can bring about change.
- Mary@Mayo
March 9, 2010 6:49 p.m.
I support the right to VBAC, however current standards require that a full anesthesia and OR team be immediately available throughout the entire VBAC labor. VBACs occur at all hours, everyday, and not always one at a time. At our community hospital, we often must delay or reschedule other C-sections, to leave the OR available for the laboring VBAC. I do not consider VBAC a luxury, however, many are impacted by the decision to VBAC.
- Dennis
March 2, 2010 1:37 p.m.
I think if a VBAC book was required reading for every woman's 1st pregnancy, there would be an extremely lower amount of C-sections performed.
- Marianne
February 20, 2010 1:26 p.m.
I would think a hospital not safe for VBAC would not be safe for any birth emergency.
- Blair
February 19, 2010 10:23 p.m.
The availability of VBAC should NOT be considered a "luxury." It is totally illegal to require a woman to undergo a repeat cesarean against her will. Every woman in this country has the right to informed consent and informed refusal. If you show up in labor the EMTALA requires that hospital to treat you regardless if you consent to a cesarean or not. Let's not forget here that a VBAC is just a vaginal birth - it's not some "procedure" that the hospital may not be able to provide. It's nothing more than a vaginal birth - that's all. And if a hospital cannot handle emergencies (which can, and do, occur in ANY type of birth, then they shouldn't be any patients there at all.)
- TheFeministBreeder
February 19, 2010 8:45 a.m.
I am pro VBAC all the way having experienced it with the birth of my 2nd child. I don't think the availability of a c-section, however, should be considered a "luxury."
- Debbie
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35 comments posted