VBAC stands for vaginal birth after caesarean (C- section) and refers to when a woman has a baby vaginally after previously having an emergency or elective (planned) C-section.
Provided there are no other medical complications with you or your baby, it is 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 complications, such as increased blood loss and infection rates, than vaginal births, as well as increased 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 C-section. There may be feelings of disappointment about their baby needing 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. A debrief could help you to understand the reasons why a C-section was recommended for you last time and enable you to decide if a vaginal birth or elective caesarean is right for you this time .
Here are some facts* to think about if you are considering a VBAC:
- Your chance of a successful VBAC is 72-75%
- If you have had one or more previous vaginal births, your VBAC success rate increases to 85-90%
- The risk of scar rupture during a VBAC is very low, at 0.5%
- Induction/augmentation of labour increases the risk of scar rupture two- to three-fold compared to spontaneous VBAC labour
- Compared to spontaneous VBAC labour, induction/augmentation of labour increases the chances of needing a C-section by 1.5-fold
How to increase your chances of achieving a VBAC:
- Avoid any type of induction of labour. If there is evidence to suggest that you or your baby are at risk from prolonging your pregnancy, discuss your options at length with your obstetrician and make sure to use the B.R.A.I.N. acronym. A labour that starts naturally is less likely to need medical intervention.
- If you choose to give birth in hospital, research their success rates for VBAC and choose a hospital that has a higher rate
- 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 yourbirth partnerso 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 doctor or 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 effectivepain 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.
Summary
The decision on how to birth your baby following one or more C-sections ultimately rests with you. However, every woman, every baby and every pregnancy are different and thoughtful discussions with your obstetric team are paramount in the decision-making process. Careful consideration of each woman’s individual circumstances and an objective understanding of the potential benefits, risks, and alternatives, by both the woman and her obstetric team, are necessary. You will find a wealth of useful information to help inform your choices in our blogs, free guides, e-books, antenatal classes & webinars, and on our social media channels.
*Royal College of Obstetricians and Gynaecologists (October 2015) “Birth after previous caesarean birth” Green Top Guideline No. 45, RCOG: London
