VBAC (vaginal birth after caesarean section) is when a woman has a baby vaginally after previously having an emergency or elective (planned) caesarean section.
Provided there are no other medical complications with you or your baby, it is much safer to plan for a vaginal birth even if you have had more than one c-section previously.
Caesarean sections carry a higher risk of increased blood loss and infection rates than vaginal births, as well as increasing the chances of having problems with your placenta in any future pregnancies.
For some women, a desire to give birth vaginally is very strong after a caesarean section, as they may have been disappointed that their baby needed to be born by this method. Other women may need to work through issues surrounding their previous caesarean, as it may have caused some trauma or upset at that time.
If you feel that you would benefit from a “Debrief”, - where you can discuss your previous emergency or elective caesarean- you can arrange this with your doctor or midwife. It can help you to understand the reasons why a caesarean section was recommended for you last time, and enable you to decide if a vaginal birth or elective caesarean is right for you.
Here are some interesting statistics* to think about if you are considering a VBAC:
- Depending upon which hospital you choose, you are 70- 90% likely to achieve a VBAC if you plan one
- The chance of having a problem with your previous caesarean scar is low- 0.5-2%
- The risk of scar rupture in VBACs is very low, at 0.35%
How to increase your chances of achieving a VBAC:
- Avoid any type of induction of labour unless there is evidence to suggest you or your baby are at risk from prolonging your pregnancy. A labour that starts naturally is less likely to need medical intervention.
- Prepare well for your birth. Your hormones will work better if you labour in the place you feel safest and most comfortable, so think carefully about where you would like to labour and give birth.
- Make a birth plan and discuss this with your birth partner so they are aware of your wishes and are able to help advocate for you in labour.
- Think about how you would like your baby’s heart rate to be monitored in labour. There are several options: continuous monitoring, wireless monitoring and intermittent monitoring. You can discuss the advantages and disadvantages of different monitoring with your midwife.
- Try to remain as upright and active as possible in labour. Try to “zone out” of everyday distractions and tune into your body’s cues as your labour progresses.
- Although an epidural can offer effective pain relief, it will restrict your movement, making it more difficult for you to widen your pelvis for birth and increase your need for assistance at the birth with forceps or ventouse. Consider an epidural if there is a medical need or after you have tried other types of pain management.
You may benefit from taking a hypnobirthing course. This can help you to develop coping strategies for your labour and birth.
*Royal College of Obstetricians and Gynaecologists (October 2015) “Birth after previous caesarean birth” Green Top Guideline No. 45, RCOG: London