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VBAC (vaginal birth after C-section)
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/vbac/MY01143
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Definition
If you've delivered a baby by C-section, you may have a choice with your next pregnancy — schedule a repeat C-section or attempt vaginal birth after C-section (VBAC).
Years ago, a C-section ended any hope of future vaginal deliveries. But today, thanks largely to changes in surgical technique, VBAC is possible in many cases. In fact, an estimated 60 to 80 percent of women who try VBAC have a successful vaginal delivery.
VBAC isn't right for everyone, though. Sometimes a pregnancy complication prevents the possibility of a successful VBAC. Many local hospitals don't offer VBAC because they don't have the staff or resources to handle emergency C-sections.
Why it's done
Women consider VBAC for various reasons, including:
- Fewer complications. You're less likely to get an infection and have serious blood loss with a successful VBAC than with a repeat C-section. If the VBAC fails, however, the baby must be delivered by C-section — which carries a higher risk of infection than a planned repeat C-section.
- Shorter recovery time. You'll have a shorter hospital stay after a VBAC than you would after a repeat C-section. Avoiding surgery will help your energy and stamina return more quickly, as well as reduce the expense of childbirth.
- More participation in the birth. For some women, it's important to experience a vaginal delivery. If you have a successful VBAC, you may get to hold and breast-feed your baby sooner than you would after a repeat C-section.
- Impact on future pregnancies. If you're planning a larger family, VBAC may be a better option with each subsequent delivery. Repeat C-sections get more complicated each time, while repeat VBACs tend to become progressively easier.
The chances of a successful VBAC are higher if:
- You have only one prior low transverse uterine scar — the most common uterine incision for a C-section — and no other uterine scars
- You and your baby are healthy and your pregnancy is progressing normally
- The reason you had your prior C-section isn't a factor this time
- Your labor begins naturally on or before your due date
- You've had a previous successful vaginal delivery
The chances of a successful VBAC are lower if:
- Your pregnancy continues beyond your due date
- You have an unusually large baby
- You've had two or more C-sections and no vaginal deliveries
- You're obese
You're not a candidate for VBAC if you had a uterine rupture during a previous pregnancy or any health conditions that might affect a vaginal delivery. Similarly, VBAC isn't recommended if you've had a classical incision — the type of uterine incision most likely to rupture during labor. VBAC may be possible with twins if both babies are positioned headfirst, but VBAC generally isn't an option for triplets or other multiples.
Risks
VBAC poses potentially serious risks, including:
- Failed attempt at labor. Labor results in a repeat C-section for 20 to 40 percent of women who attempt VBAC, often because the baby doesn't tolerate labor.
- Uterine infection. If you must have a repeat C-section after labor has begun, you face a slightly higher risk of C-section complications — such as a uterine infection — than if you had a planned repeat C-section.
- Uterine rupture. Rarely, the uterus may tear open along the scar line from a prior C-section. If your uterus ruptures — either before or during labor — an emergency C-section is needed to prevent life-threatening complications, including blood loss, infection and brain damage for the baby. When delivery takes place in a hospital equipped to handle such emergencies, rarely is the baby at risk. In some cases, however, the uterus may need to be removed (hysterectomy) to stop the bleeding. If your uterus is removed, you won't be able to get pregnant again.
For some women, pelvic floor problems also are a concern. The weight and pressure of pregnancy can weaken the pelvic floor muscles that support the uterus, and vaginal delivery may stretch the pelvic floor muscles even farther. This can lead to temporary urinary incontinence.
How you prepare
If you choose VBAC, boost your odds of a positive experience:
- Learn about VBAC. Take a childbirth class on VBAC. Include your partner or another loved one, if possible. Also discuss your concerns and expectations with your health care provider. Make sure he or she has your complete medical history, including records of your previous C-section and any other uterine procedures.
- Make sure your health care provider will be available throughout your labor. Close monitoring can decrease the risk of complications.
- Plan to deliver the baby at a well-equipped hospital. Look for one that has continuous fetal monitoring, a surgical team that can be assembled quickly, and the ability to administer anesthetics and blood transfusions 24 hours a day.
- Allow labor to begin naturally, if you can. Drugs to induce labor can make contractions stronger and more frequent, which may contribute to the risk of uterine rupture — especially if the cervix is tightly closed and not ready for labor.
- Be prepared for a C-section. Some complications of pregnancy or delivery may require a C-section, even if you had your heart set on a vaginal delivery. For example, you may need a C-section if you develop preeclampsia or other pregnancy complications, there's a problem with the placenta or umbilical cord, your baby is in the wrong position, your labor fails to progress, or your baby doesn't tolerate labor.
It's also important to take good care of yourself. Eat a healthy diet, include physical activity in your daily routine — with your health care provider's OK — and get plenty of rest. These good-for-you habits will help you prepare for a vaginal delivery, as well as the demands of caring for a newborn.
What you can expect
If you choose VBAC, your prenatal care will be just like the care you'd receive during any other healthy pregnancy. When you go into labor, you'll follow the same process as any woman expecting to deliver vaginally. This is called a trial of labor.
Here's what to expect:
- Early hospitalization. Your health care provider will ask you to report to the hospital promptly if your water breaks or when you begin feeling contractions. Laboring at home with a prior C-section scar isn't recommended.
- Pain control. If you choose medication, you'll have various options — typically including epidural anesthesia.
- Continuous electronic monitoring. The medical team will keep a close eye on your baby's heart rate and will check on you often to make sure that labor is progressing normally. A fetal monitor may be attached to your baby's scalp.
- Less tolerance of abnormal labor patterns. A prolonged or difficult labor increases the risk of uterine rupture. Medication to stimulate contractions may pose the same risk. You may need a repeat C-section if your labor isn't progressing well or your baby doesn't tolerate labor.
Remember, your ultimate goal is a healthy baby and a healthy mom — regardless of how you get there.
- Welischar J, et al. Trial of labor after cesarean delivery. http://www.uptodate.com/home/index.html. Accessed Dec. 28, 2009.
- Grobman WA, et al. Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? American Journal of Obstetrics and Gynecology. 2009;200:56.e1.
- Macones GA. Clinical outcomes in VBAC attempts: What to say to patients? American Journal of Obstetrics and Gynecology. 2008;199:1.
- Vaginal birth after cesarean delivery. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp070.cfm. Accessed Dec. 28, 2009.
- Healthy pregnancy: Labor and birth. The National Women's Health Information Center. http://www.womenshealth.gov/pregnancy/childbirth-beyond/labor-birth.cfm. Accessed Dec. 28, 2009.
- Healthy pregnancy: Staying healthy and safe. The National Women's Health Information Center. http://www.womenshealth.gov/pregnancy/you-are-pregnant/staying-healthy-safe.cfm. Accessed Dec. 28, 2009.
- Baydock SA, et al. Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery. Journal of Obstetrics and Gynaecology Canada. 2009;31:36.
- Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 12, 2010.
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