A quick look at VBAC

Vaginal birth after C-section (VBAC) is sometimes a delivery option for women who are having a child after previously delivering a baby by cesarean-section.

The benefit of VBAC is to avoid the surgical procedure of another C-section, as VBAC often results in a quicker recovery and less risks and scarring from another surgery.

Risks of VBAC for mother and child are the same as those of any vaginal delivery, plus the added risk of the previous C-section scar in the mother’s uterus rupturing, although this is rare.

VBAC is not right for everyone, and the providers at CU Medicine OB-GYN East Denver (Rocky Mountain) will discuss all concerns and options with the expectant mother.

We will help you chose the right birth plan, taking all of your concerns and needs into consideration. Our OB-GYNs are all skilled at VBAC delivery.
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What is a VBAC?

While cesarean delivery is fairly safe and can be a lifesaving procedure in certain circumstances, it is still surgery and carries risks for the mother and baby alike. In many circumstances, a vaginal birth is considered a lower risk delivery option, but VBAC is not always an appropriate option.

In years past, a prior C-section required that subsequent deliveries had to be by C-section also. That has since changed, and the American College of Obstetricians and Gynecologists (ACOG) recommends that vaginal birth after cesarean delivery be considered, in order to reduce the risk of childbirth complications.

Benefits of VBAC

  • Lower risk of complications including bleeding, infection and clotting.
  • Quicker recovery time and shorter hospital stay.
  • Decreased uterine scarring.
  • Decreased chance of future C-section deliveries.

In general, the healing time, recovery time and risks associated with a vaginal birth are significantly lower than that of a C-section. That said, VBAC is not right for every patient. Complications during delivery, such as fetal distress, may also necessitate a C-section despite a vaginal birth plan.

Mothers may choose to deliver by C-section again, either to avoid risks associated with VBAC or for personal preference. Mothers considering having multiple children in the future may prefer a VBAC in order to limit the number of cesarean deliveries they might have in total. Statistics from the Centers for Disease Control and Prevention show that in 2018, 13.3% of births after a previous C-section were vaginal deliveries, with VBAC numbers increasing.

Some OB-GYNs and hospitals do not offer VBAC. All our providers do, as does Rose Medical Center where we deliver. All our OB-GYNs are skilled surgeons and will conduct the VBAC delivery, or the C-section if it is necessary.

Trial of labor after cesarean (TOLAC)

Before a VBAC actually occurs, we will first observe how the mother and fetus do during labor, which is known as a trial of labor after cesarean (TOLAC). If labor is not progressing or there is any evidence that the baby is not tolerating labor, then a repeat c-section will be recommended.

At CU OB-GYN East Denver, we usually schedule a cesarean delivery as a backup option, in case labor does not occur. According to ACOG, of women going through TOLAC, 60% to 80% show a probability of successful VBAC.

If a woman has had a previous c-section, then inducing labor when the cervix is not already dilated is not usually an option. Some of the medications we would normally use during the induction process can weaken the scar on the uterus (from a prior C-section) and increase the chance of the uterine scar separating or “rupturing” during labor. If a uterine rupture occurs, then an emergency c-section is indicated. Naturally occurring labor is the ideal situation for TOLAC.

TOLAC is not a “test” or “procedure.” TOLAC is the doctor and nurses carefully observing a mom’s labor course to see if it is progressing safely.

Who should consider VBAC and who should not?

There are several factors that make a woman an appropriate VBAC candidate:

  • Previous vaginal delivery, including VBAC.
  • If the prior C-section was a planned procedure, not a result of complications in labor.
  • If the prior C-section incision was a low-transverse (sideways cut) uterine incision, which has a low risk of rupture of the scar, from 0.5%-1%.

Because the rupture of the previous uterine scar can be a serious, life-threatening complication for mother and baby during VBAC, it is important that our OB-GYN has the surgical records of the woman’s previous C-section.

There are also factors that would indicate a woman is not an appropriate candidate for VBAC delivery:

  • If the prior C-section incision was a vertical (up and down) uterine incision, the risk of rupturing the uterine scar is 10%, due to the forces being put on the scar during contractions.
  • Women with a previous uterine rupture.
  • If a previous C-section was performed after the woman pushed for hours and the baby still didn’t fit, as the next baby is usually even larger.
  • A prior cesarean in the last 18 months.
  • The fetus is very large.

When considering VBAC, our doctors will discuss all options and concerns with the mother in order for her to make the best delivery plan. Depending on health history, goals and the mother’s individual risks, our doctor will gauge the likelihood of a successful VBAC – which may change throughout pregnancy, especially if certain risk factors arise.

The reason a woman underwent a prior C-section is one of the biggest factors in determining if she may need a C-section again. Women who have undergone multiple C-sections or who are likely to have health complications or a baby with a higher birth weight (more than 10 pounds) are less likely candidates for vaginal delivery.

As with any medical decision, a thorough discussion between doctor and patient should cover health history, goals and potential complications.

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Vaginal birth after cesarean (C-section) delivery risks

Delivering a baby comes with inherent risks, no matter the method of delivery. Women who deliver vaginally are at risk of vaginal tears that require stitches or extra healing time. They may also experience issues with organ prolapse or incontinence after a vaginal birth. If successful, a VBAC still carries fewer risks than a repeat C-section delivery.

However, if an attempted VBAC fails, the woman is likely to undergo an emergency C-section. This carries the risks of any other C-section, including infection, scarring, severe bleeding and injury to other organs at the time of delivery. This may require a blood transfusion.

As a result of these risks, VBAC should be performed by experienced OB-GYNs in a hospital setting where surgical facilities are on hand in case an emergency C-section is needed.