Vaginal Birth After Cesarean

Women who have had a prior c-section have the option of a undergoing vaginal birth after c-section (VBAC) or an elective repeat c-section.  A successful vaginal birth carries a lower risk to the woman than does a repeat c-section.  Women undergoing a vaginal delivery will generally have an easier recovery with fewer problems after delivery and a shorter hospital stay than those who have a c-section.

However, there are certain individuals who are more likely to be successful for a VBAC than others.  If your prior cesarean section had been performed for a fetal issue (I.e. baby was breech, heart rate was worrisome, etc.), the likelihood of a successful VBAC approaches 85%.  If your prior cesarean section was done for a maternal reason (i.e. stopped dilating, baby didn’t fit through the pelvis), the likelihood of a successful VBAC is only around 50%.

There are risks associated with undergoing a VBAC.  The most serious risk is that of uterine rupture.  In most cases, cesarean sections are performed with a low uterine incision.  If that was the case, the risk of uterine rupture is around 1-3%.  However, if your cesarean section was not performed with a low uterine incision, the risk of rupture can be upwards of 10% and a VBAC is not medically recommended.

In cases where the uterus ruptures, an emergency c-section is needed.  If the uterus ruptures, there is a risk that the baby can be seriously injured or even die.  Another risk is for those women who end up needing a c-section after a trial of labor, there is a higher risk of infection, bleeding, and injury to organs inside the abdomen than for those women who elected to have a repeat c-section.  Recovery is also typically more difficult.

For those women who would like to attempt a VBAC, we do have certain best practice measures that need to be followed to ensure safety.  All patients must have IV access.  All patients should have an epidural catheter placed as well.  This is to ensure that if an emergency cesarean needed to be performed, anesthesia is readily available that allows you to be awake during the procedure.

All patients must have continuous fetal monitoring of the baby as well.  The fetal heart tracing is the first place where signs of fetal distress can be noted which may indicate the beginning of a uterine rupture and allows for earlier intervention.

The best situation for a successful VBAC is if you enter into active labor spontaneously with a  clear change in the cervical exam.  If you are not in labor and break your water, our medical recommendation is to proceed with a repeat cesarean section because of the increased risk of induction.  If you do not go into labor by your due date or slightly after, we also recommend a repeat cesarean to avoid the risks of an induction.

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