Normal Delivery After C-Section

Bringing a new life into this world is a journey that comes with numerous decisions and considerations. One decision is whether to have a vaginal birth after a cesarean (VBAC) or opt for a repeat c-section. VBAC has gained popularity as an alternative to c-sections, offering women the chance to experience a more "natural" birth.  

Understanding Vaginal Birth after Cesarean (VBAC)

VBAC refers to vaginal birth after a previous c-section. It provides an opportunity for women to avoid the risks and potential complications associated with repeated cesarean deliveries. VBAC is typically recommended for women with a low transverse incision (from their previous c-section) as this incision type is associated with a lower risk of uterine rupture.

Benefits of VBAC

1. Reduced risk of complications: VBAC can potentially reduce the risk of surgical complications associated with c-sections, such as infections, blood loss, and longer recovery periods. Vaginal birth allows for a shorter hospital stay and a faster return to daily activities.
2. Avoidance of potential risks: Multiple cesarean deliveries increase the risk of multiple caesarian deliveries including placental abnormalities in subsequent pregnancies. VBAC can help women avoid these complications, promoting better long-term maternal health.
3. Bonding and breastfeeding advantages: VBAC enables immediate skin-to-skin contact and breastfeeding initiation, promoting a stronger emotional bond between the mother and baby. These early interactions can positively impact breastfeeding success rates.

Can you get a VBAC?

While VBAC is a viable option for many women, certain factors may influence its success.

1. Type of uterine incision during previous cesarian: The most favorable uterine incision for VBAC is a low transverse incision, which is less likely to result in uterine rupture during subsequent labor. For women who have had a prior high vertical (classical) incision, VBAC is not recommended because of associated risks.
2. Previous vaginal birth experience: Women who have previously had a successful vaginal delivery have a higher chance of achieving a successful VBAC. Similarly, many healthcare providers do not offer VBAC if someone has more than two prior C-sections.
3. Reason for previous cesarean section: If the previous c-section was performed due to non-recurrent conditions such as a breech presentation or fetal distress, the likelihood of VBAC success is generally higher.
4. Time since last delivery: The risk of uterine rupture is higher if VBAC is opted for when 18 months or less have passed since the last delivery.
5. Other health concerns: A C-section might be recommended if there are placental problems, if the baby is in an abnormal position, or the mother is carrying triplets or more babies. If the expectant mother has had other uterine surgeries, such as for fibroid removal, VBAC is not usually recommended.

Complications of VBAC

While a successful VBAC is associated with fewer complications than a repeat C-section, failed trial of labor after a C-section can cause more complications, including a uterine rupture. A VBAC also has potential risks and complications:

1. Uterine rupture: The most significant concern associated with VBAC is the risk of uterine rupture, where the scar from the previous c-section tears open during labor. A uterine rupture can lead to life-threatening maternal and fetal complications, including hemorrhage and fetal distress. Usually, an emergency C-section will be needed to prevent life-threatening complications. Treatment might involve surgical removal of the uterus (hysterectomy) which will not allow the mother to get pregnant again.
2. Emergency C-section: In the event of complications during a VBAC attempt, an emergency C-section may become necessary. A delay in performing the c-section can pose risks to both the mother and baby.
3. Increased monitoring: During a VBAC, continuous fetal monitoring is often required to identify any signs of distress. This monitoring can limit a woman's mobility and may increase the likelihood of medical interventions, such as labor augmentation or instrumental delivery.

Counseling and Decision-making

Due to the potential risks involved, healthcare providers often engage in comprehensive counseling sessions with women considering VBAC. These sessions allow women to weigh the benefits and risks based on their specific circumstances and preferences. Discussions may also involve creating a birth plan that outlines the preferred course of action in different scenarios. It is essential for expectant mothers to have open and honest discussions with their healthcare provider to assess their eligibility for VBAC based on individual factors and circumstances.

While VBAC can be a safe and successful option for many women, it is crucial to weigh the potential benefits against the associated risks to make an informed decision that prioritizes the health and well-being of the mother and baby. Every birth journey is unique, and what matters most is the safe arrival of a healthy baby and a positive experience for the mother. Your healthcare provider can best guide you in this.