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VBAC delivery: All you need to know about Vaginal Birth After Cesarean

Lareese Craig
by Lareese Craig Published on November 10, 2013

Trying for a vaginal birth after having a previous child by cesarean can be a daunting decision to make. If you're considering VBAC (vaginal birth after cesarean) you'll want to know all the facts: What it is, how to prepare for it, the risks and complications involved and the rewards.

If you delivered your first baby via cesarean you probably have a strong desire to give birth naturally the second time round.

As painful as it is, it's every mother's instinct to want to experience every joy (and pain) of delivering her child with minimal intervention.

It's important to have this opportunity as vaginal birth has many physical and psychological benefits for both mother and baby.

What is a VBAC?

A vaginal birth after cesarean (VBAC), also known as trial of labor or unassisted birth after delivery (UBAC), should be discussed with your midwife so you can work out a birthing plan that suits you and reach an informed decision together.

And of course, having previously gone through a cesarean delivery, if you're keen to try for a VBAC then you'll probably have a few questions, doubts and concerns, which is why we spoke to midwife Gemma Raby to get the lowdown on VBAC...

Why would I want to opt for a vaginal birth after cesarean?

"Many women often feel that they want to experience a vaginal delivery because the previous baby may have been born by cesarean without a labor. This can cause women to feel less involved in the delivery process.

"​Most women also recover much quicker following a vaginal delivery than after a cesarean section so this is one benefit of VBAC."

What about rupture of the uterus? Is this a high risk?

"The uterine muscles are very elastic, they stretch as the pregnancy progresses and then contract during labor which enables the cervix to dilate. Scar tissue is less elastic, therefore there is a risk that during later pregnancy, (but more so during labor when contracting) the old scar will weaken and 'split', this is a ruptured uterus.

"When a woman is in labor spontaneously the risk of uterine rupture is approximately 0.15%, if the labor is induced this risk rises to approximately 0.88%.

"​The risk increases slightly again if there has been more than one previous cesarean to approximately 0.90%, however some research indicates that the risk of rupture is no greater following one cesarean than after three.

"Essentially the risks are statistically very small, however the decision to have a VBAC should always be made with an obstetric consultant as there may be individual risk factors to consider."

How can you prepare for VBAC?

"Make sure the decision has been made with the support of your birth partners and after discussion with the obstetric and midwifery teams. These professionals are experts in their field and are there to ensure you and your baby have the best possible outcome and a safe delivery.

"Make a birth plan, some women are happy to labor spontaneously with VBAC but wouldn't like to be induced, know your options. Many women successfully use hypnobirthing to accomplish a vaginal delivery following cesarean, in fact there are specific courses for women planning a VBAC.

"It's usually recommended to deliver in hospital due to VBAC being a higher risk labor, so meet with the midwives to discuss what is and isn't recommended during labor, there may be guidelines in place which may impact on the birth plan you've made. Remember, preparation will help you to retain control of your birth experience."

How does VBAC differ from cesarean delivery?

"If a cesarean is done as an emergency it can be a frightening time. Women often express a lack of control in the decision-making process even though efforts are always made to limit this. Elective cesarean eliminates the need for labor, your baby's birthday is pre-booked and this can eliminate some of the stress of the unknown.

"Experiencing VBAC means going through contractions. There is no certainty as to the date and time when labor will start. This means that you will get to experience your own individual labor which can be very fulfilling. Remaining active will increase the chances of a successful VBAC, use active birth techniques, TENS, breathing and hypnobirthing."

Is there anyone who isn't suitable for a VBAC?

"This can be related to the reasons why the cesarean was performed in the first place. It's important to understand the reasons for your previous surgical delivery, debriefing with senior midwives and making decisions with obstetric consultants can help you to make the safest delivery for you."

What are the risks and complications?

"Approximately 25% of women attempting a VBAC will require an emergency cesarean, sometimes due to concerns for the baby's wellbeing, sometimes if the labor is not progressing as expected. The risk of complications such as bleeding and infection are higher with an emergency than an elective cesarean, however the risk of cesarean with VBAC is only slightly higher than the same risk during delivery of a first baby.

"The main risks are those associated with rupture of the scar, also if you've never labored before or successfully delivered vaginally, your ability to labor and deliver a baby vaginally is unknown, however this is also true during a first pregnancy and labor.

"I would always advise women considering a VBAC to make the decision with the professionals who will care for you during your labor, many units offer advice specific to VBAC so make the most of these services."

If you've got any VBAC advice for moms-to-be we'd love to hear from you, tweet us @wewomenUSA

by Lareese Craig

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