Vaginal Birth After Cesarean (VBAC) offers individuals who have previously undergone a C-section the opportunity to deliver their next baby vaginally. It offers potential benefits like avoiding major abdominal surgery, reduced infection risk, and quicker recovery. While it can be a safe choice for many, VBAC requires careful evaluation and consideration of individual circumstances to ensure the best possible outcome.
Determining VBAC Eligibility
Eligibility for a VBAC is determined by several medical factors, with the type of previous C-section incision being a primary consideration. A low-transverse uterine incision, a horizontal cut across the lower, thinner part of the uterus, makes someone a good candidate for VBAC. This type of incision carries the lowest risk of uterine rupture during a subsequent vaginal birth attempt. In contrast, a high vertical incision, also known as a classical incision, or other uterine surgeries like fibroid removal, preclude a VBAC due to an increased risk of uterine rupture.
The number of previous C-sections also plays a role in VBAC candidacy. The American College of Obstetricians and Gynecologists (ACOG) suggests that individuals with one or even two prior low-transverse cesarean deliveries are considered candidates for VBAC, provided no other contraindications exist. However, the risk of complications, such as placenta accreta, can increase with each subsequent C-section, making the decision more complex.
The reason for the previous C-section also influences eligibility. If the prior C-section was for a non-recurring issue, such as a breech presentation or fetal distress, the chances of a successful VBAC are higher. However, if the previous C-section was due to labor not progressing, or “labor dystocia,” the success rate for a VBAC is lower. Certain medical conditions, like placenta previa or a history of uterine rupture, are absolute contraindications for VBAC attempts.
The VBAC Labor Experience
During a VBAC attempt, also known as a trial of labor after cesarean (TOLAC), continuous monitoring of both the birthing person and the baby is standard practice. This involves close observation of maternal vital signs, uterine contractions, and continuous electronic fetal heart rate monitoring. The fetal heart rate is an important indicator, as an abnormal tracing can be an initial sign of uterine rupture in about 70% of cases.
Medical staff will also watch for other signs that indicate a need for a repeat C-section. These include severe abdominal pain that is disproportionate to typical labor pain, a sudden loss of fetal station, or the presence of blood in the urine. Maintaining intravenous (IV) access is a standard precaution for rapid administration of fluids or medications if an emergency arises. While labor progression is carefully assessed, epidural anesthesia is not discouraged and can be used for pain management without reducing the chance of a successful VBAC.
Preparing for a VBAC
Preparation for a VBAC attempt encompasses various aspects, beginning with selecting a supportive healthcare provider and birthing facility. Choosing a provider who is supportive of VBACs and has a track record of successful vaginal births after C-sections can impact the experience. It is equally important to choose a hospital that is equipped to handle potential complications, including the ability to perform an emergency C-section quickly if needed.
Open and continuous communication with the medical team is also an important aspect of preparation. Discussing your health history, the reasons for your previous C-section, and your preferences for labor and delivery helps create a personalized birth plan. Understanding the typical progression of labor and various pain management options can also contribute to feeling more confident and prepared.
Mental and emotional preparation involves addressing any fears or anxieties related to past birth experiences or the upcoming labor. Listening to positive birth stories, engaging in positive affirmations, and potentially working with a doula or support group can foster a more confident mindset. Physical preparation includes maintaining a healthy lifestyle with balanced nutrition and regular, pregnancy-safe exercise. Engaging in activities like walking or jogging for at least 200 minutes per week can increase the chance of a successful VBAC. Consulting with a pelvic floor physical therapist is also beneficial for exercises that promote pelvic floor health and optimize pushing techniques.
Understanding Potential Labor Outcomes
The success rate for VBAC attempts varies, ranging from 60% to 80% for individuals with one prior low transverse C-section. However, this rate can be higher, around 70-75%, for those who have had a previous vaginal delivery. Factors that positively influence success include spontaneous labor onset and the reason for the previous C-section not being related to labor progression issues.
Conversely, certain factors can decrease the likelihood of a successful VBAC, such as labor induction, advanced maternal age (over 35), a short interval between pregnancies (less than 18 months), or a large fetus. If a VBAC attempt is not progressing safely or if concerns arise, medical professionals will transition to a repeat C-section. This occurs in 20% to 40% of VBAC attempts. While an emergency C-section after a trial of labor carries a slightly higher risk of infection and bleeding compared to a planned C-section, the ultimate goal remains a safe birth for both the parent and the baby.