Everything you wanted to know about a VBAC (Vaginal Birth After C-section)
What is the criteria for you to have a VBAC (Vaginal Birth After C-section) and what are the health risks you should be aware of?
Did you previously have a C-section to deliver your baby, but then this time round you are hoping to deliver your next baby naturally via a VBAC (which stands for Vaginal Birth After C-section)?
Then you will need to know whether your doctor will give you the greenlight after carefully assessing your pregnancy and taking your medical history into consideration.
It is also important that you learn about the risks involved when opting for a VBAC and how you should prepare yourself for one.
Just because you previously had a C-section, this does not mean that you will automatically have to deliver your next baby that way too.
According to the KK Women's and Children's Hospital (KKH)in Singapore, pregnant mums who previously have had one uncomplicated lower segment C-section (LSCS) and no other medical issues in the current pregnancy are suitable candidates for VBAC.
Factors that will help you have a successful VBAC include:
- No more than two low transverse C-section deliveries
- No additional uterine scars, anomalies or previous ruptures
- Your doctor should also be prepared to monitor your labour and perform (or refer for) a C-section if needed
- If the original reason for your previous C-section delivery is not repeated with this current pregnancy
- You have no major medical problems or health issues
- Your baby is not larger than average
- Your baby is head-down (or engaged)
- You have had a vaginal birth before
- Your labour starts spontaneously
Factors that will affect your chances of having a successful VBAC are:
- Being an older mum
- You are overweight or obese
- Your baby has a a high birth weight (average birth weight for babies in Singapore is 3.2kg)
- Your pregnancy has gone beyond 40 weeks of gestation
- There is a short time between your pregnancies (18 months or less)
- The reason for your previous C-section delivery was due to Dystocia
Remember to talk with your doctor about your individual chance of success and critically weigh out all the benefits and the risks of a VBAC before moving forward.
What are the risks?
According to KKH, the chance of a successful VBAC is around 60% to 70%, and is generally higher for women who have had previous successful vaginal deliveries before.
However the chances may be lower if the reason for the previous C-section was due to Cephalopelvic Disproportion (CPD), which is when the baby is too big to pass through the pelvis.
If you are considering getting a VBAC, there are a few potential serious risks involved that you should be aware of such as:
It is very risky if you have to deliver your baby via an emergency C-section after a failed VBAC -- the reasons for this can be due to your labour not progressing, or if there is evidence of foetal distress.
Although this is rare, your uterus might tear open along your old scar line from the prior C-section.
If your this happens, an emergency C-section is needed to prevent any life-threatening complications such as heavy bleeding or you getting an infection; and possibly even brain damage for your baby.
In some cases, a hysterectomy might have to be performed (to remove your uterus) in order to stop the bleeding -- therefore you will not be able to get pregnant again in future.
Foetal heart rate monitoring will help to to detect any signs of foetal distress and is usually a routine part of the VBAC procedure.
If your baby's life is at risk from foetal distress or any other complications, you will have to consider getting a C-section delivery instead.
Dystocia is when you have a long and difficult labour due to slow cervical dilation, if your baby is too large for the pelvic opening, or if your baby is in an abnormal position.
If such complications are detected early, then you would probably be advised to opt for a C-section instead of a VBAC.
Mums with a history of herpes will be strongly encouraged to deliver by C-section because of the risk of passing herpes to your baby during delivery.
Tests will be made to examine the cultures during your last weeks of pregnancy and if an active virus is found then that calls for a C-section to be scheduled.
During a vaginal birth, the pressure from your baby’s head pushing through can cause tears and lacerations in your perineum (that sensitive area between your vagina and your anus) and possibly your cervix too.
All women who are delivering vaginally are at risk of getting a small tear and you should also expect some perineal postpartum pain.
If you opt for a VBAC, here are a few steps you can take increase your chances of an overall positive experience:
- Learn more about VBAC by taking a childbirth education class specifically on VBAC, read up about it, and discuss it in more detail with your doctor
- Make sure your doctor has your complete medical history, including the records of your previous C-section and any other uterine procedures or surgeries
- Talk to other mums who have experienced a VBAC before to get their first-hand accounts
- Choose a well-equipped hospital to deliver your baby which is equipped to handle an emergency C-section (should you require one)
- If possible, allow your labour process to begin naturally, as drugs that are used to induce labour can make contractions stronger and more frequent, which might increase the risk of a uterine rupture
- Be prepared for a C-section in case any complications may arise during your pregnancy or the delivery
Even if you have your heart set on getting a VBAC, remember that each pregnancy is unique and you should trust your medical team's decision should any complications arise which will require you to go through another C-section instead.
The most important thing is that your baby is delivered safe and sound and will be in your arms once it's all over!
Are you considering getting a VBAC? Or have you had one before? Do share your personal stories with us or tips for other mums in the comments section below