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Considering VBAC? 5 Questions to Ask

Heather Rupe, DO - Blogs
By Heather Rupe, DOBoard-certified OB/GYNSeptember 25, 2014
From the WebMD Archives

With the cesarean section (C-section) rate in the U.S. approaching a staggering 32%, more women are faced with the often difficult decision of whether or not to attempt a vaginal delivery after C-section (VBAC). Of women who attempt VBAC, 30% will end up with another C-section during labor. The 70% of women who have a successful VBAC experience a quicker, less painful recovery and a lower complication rate for baby and mom.

But there are risks of complications with VBAC, too. They are rare, but when they do happen they can be extreme. When a woman has a C-section, a cut is made in the lower part of her uterus to pull out the baby. The doctor then sews the uterine incision neatly back together, but it is always a bit weaker. With her next pregnancy, if a vaginal delivery is attempted, the pressure of labor contractions can cause the old uterine scar to break open 1% of the time. If this rare uterine rupture does happen, the mom risks hemorrhage and loss of her uterus. In extremely rare cases, oxygen can be cut off to the baby, leading to brain damage or death.

If you have had one to two C-sections, ask yourself these questions as you consider your next delivery.

How many kids do I want to have?

A scheduled repeat C-section carries its own risks, including bladder injury, infection, and increased rates of NICU admission for the baby. A C-section is a major surgery, and the more of them you have, the higher your chances of complications. The complications related to a fourth C-section are somewhat higher than the third, and a fifth C-section carries extremely high risk. A pregnancy after four C-sections has a 10% chance of the placenta growing into the uterus (a condition called accreta), which is dangerous and usually results in a preterm delivery and a hysterectomy.

If you’re thinking about having more than three children, you should strongly consider a VBAC.

How important is a vaginal delivery to me?

All births are beautiful miracles, but a VBAC delivery is almost triumphant. As the woman delivers, she finally gets to experience the birth that has been two pregnancies in the making. A lot of women have a strong desire to have a vaginal delivery. They feel this is an important life experience, and for them a 1% risk may seem worth it — others not so much.

Have I had other vaginal deliveries?

If you’ve had other vaginal deliveries before your C-section, your chance of successful VBAC is higher. Your risk of rupture is still there, but your chance for successful vaginal delivery is around 90%.

Why did I have my first C-section?

Is the reason for your first C-section something that can be changed? Was your first baby a breech 11-pounder, and this one is normal-sized and head down? If so, you might be a good candidate for VBAC.

But if you were carrying a normal-sized baby last time, and you went into spontaneous labor and were unable to deliver vaginally, then it’s likely that the same thing could happen again. So, perhaps a repeat C-section might be a better option.

There’s no “magic 8 ball of labor” that will tell us for sure if your VBAC will be successful. But if the reason for your first C-section is not present this time, than a vaginal delivery is more likely to be successful.

Do my provider and hospital offer VBAC?

If you plan to try for a VBAC, you need to make sure your hospital is equipped and your provider is on board. In order to improve the safety of VBACs, hospitals have to be ready at a moment’s notice to do an emergency C-section in case the uterus breaks. When a break happens, the placenta usually becomes detached from the uterus, meaning no oxygen for the baby. The obstetrician must get the baby out very quickly to prevent brain damage from lack of oxygen. If you live in a more rural area, you may need to travel to a more urban hospital in order to get a VBAC.

In the end, each woman’s unique pregnancy history will determine whether VBAC is the right option for her. If you’re done having children with two, the chance of an easier recovery may not be worth the risk of rupture. But if you had a terrible experience with your first C-section and have a strong desire to experience natural child birth or want a larger family, then a 1% risk may seem minimal to you. Talk to your provider about your overall chance of a successful VBAC as you carefully weigh the risks and benefits.

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About the Author
Heather Rupe, DO

Heather Rupe, DO, is a board-certified OB/GYN in private practice in Franklin, TN, and serves as the vice chief of staff at Williamson Medical Center. She is the co-author of The Pregnancy Companion: A Faith-Filled Guide for Your Journey to Motherhood and The Baby Companion: A Faith-Filled Guide for Your Journey through Baby’s First Year.

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