Vaginal Birth After Cesarean (VBAC)
For many years, the medical community believed that once a woman had given birth via a cesarean section that any additional babies she has must also be born via c-section. In fact, safe and successful vaginal deliveries are possible after a c-section, giving women the option to experience the childbirth process if they wish.
Experts estimate that 60 to 85 percent of women who had cesareans the first time around are able to have a normal labor and deliver vaginally their second, third or subsequent baby without incidence. Successful VBAC rates are higher for those women with non-recurring causes (such as a breech presentation with the first baby, but the favorable head-down position with the second) and those who have previously delivered vaginally.
There are many reasons a woman might choose to deliver a baby vaginally after a cesarean. Some women feel a sense of accomplishment with a vaginal birth, others have a medical condition which makes a repeat c-section riskier, while others do not want to repeat the lengthy and often painful recovery process associated with a c-section. Cesarean is also considered major surgery and, as such, is not without risks to mother and child, such as hemorrhage, infection and venous thromboembolism, and may place future pregnancies at increased risk for placenta previa, placenta accreta, uterine rupture, and peripartum hysterectomy. In addition, the process of labor and delivery helps prepare your baby for life outside the womb by helping him or her to expel much of the mucus and fluid from his lungs. There is also a decreased incidence of surgery-related fetal injuries (lacerations, broken bones) with a VBAC.
The type of uterine incision (which may differ from your abdominal incision) you received during your previous c-section will largely determine whether or not you will be able to attempt a VBAC. If you had a low transverse incision (horizontal, across the lower part of the uterus), there is an excellent chance you can deliver vaginally without incidence. However, if you had a classic incision (vertical, down the middle of your uterus), your obstetrician may not allow you to attempt a VBAC because this type dramatically increases your chances of uterine rupture. Uterine rupture is the most common problem associated with VBAC; however, it happens very rarely – in approximately 1 to 2 percent of VBACs. Your doctor will be able to assess your risk and advise whether VBAC is an option for you.
While the ACOG considers oxytocin use during VBAC acceptable, induction of labor, regardless of the method used, is increasingly recognized as a risk factor for uterine rupture, according to the AAFP. Recent VBAC studies have shown three to five times more ruptures among induced mothers compared with those having spontaneous onset of labor, and the AAFP recommends prostaglandins and oxytocin (Pitocin) be used with great caution during VBAC.
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