Vaginal Birth After Cesarean Delivery (VBAC)

What is Vaginal Birth After Cesarean Delivery?

Vaginal Birth After Caesarean Delivery (VBAC) is a term for delivering a baby vaginally after previously having a baby through a caesarean section (C-section). Some women prefer VBAC to avoid the potential complications and recovery time associated with repeat C-sections.

Who is Suitable for VBAC?

Several factors can influence the decision and success of a VBAC, including:

The type of uterine incision used in previous C-sections: A low-transverse incision is the most favourable for VBAC. A vertical or "classical" uterine incision carries a higher risk of uterine rupture and is usually a contraindication for VBAC.
The reason for the previous C-section: A VBAC might be more likely to be successful if the previous C-section was due to a non-recurring condition (like a breech presentation or foetal distress).
The number of previous C-sections: The risk of complications increases with the number of previous C-sections.
Health conditions of the mother and baby: VBAC might not be recommended if there are certain health conditions like placenta previa, certain types of multiple pregnancies, or if the baby is very large (macrosomia).
Availability of surgical and anaesthesia personnel: VBAC should be attempted only at facilities equipped to respond to emergencies, with physicians immediately available to provide emergency care.

These are general factors, and an obstetrician should evaluate each individual's situation to make the best decision.

Benefits of VBAC

Shorter recovery time: A vaginal birth usually requires a shorter hospital stay and recovery than a C-section.
Lower risk of infection: C-sections carry a risk of infection at the incision site or in the uterus.
Less blood loss and lower risk of transfusion.
Lower risk of injury during surgery: During a C-section, there's a risk of injury to other organs, such as the bladder.
Avoid surgical complications related to multiple caesarean deliveries such as hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placenta conditions (such as placenta previa or placenta accreta) in future pregnancies.

Alternative Options to VBAC

The main alternative to VBAC is an Elective Repeat Cesarean Delivery (ERCD). This is when the decision is made to schedule a caesarean delivery rather than attempting a VBAC. This might be chosen if medical reasons make vaginal birth more risky or due to the mother's preference.

What Happens During a VBAC?

A VBAC generally proceeds like a regular vaginal delivery. The woman goes through early labour, active labour, and pushing. However, throughout labour, the healthcare team closely monitors the mother and baby to watch for any signs of complications.

Monitoring often includes regular ultrasounds to examine the uterus and scar from the previous C-section and continuous foetal monitoring to ensure the baby is not distressed. If complications do arise, such as signs of uterine rupture or foetal distress, an emergency C-section may be performed.

Recovery after VBAC

Like any vaginal delivery, recovery from a VBAC tends to be quicker and less painful than recovery from a caesarean section. Here's a general idea of what you might expect during recovery from a VBAC:

Immediately After Delivery:

After a successful VBAC, you'll stay in the delivery room for a short monitoring period. This allows the healthcare team to ensure there aren't any immediate complications.

Your baby will also be assessed and monitored closely. If all is well, skin-to-skin contact and breastfeeding can be initiated soon after birth.

First Few Hours and Days:

You might feel sore and tired after the delivery. Pain is usually managed with standard post-delivery pain medication, like ibuprofen.

You'll be encouraged to get up and walk around fairly soon after delivery, which can help speed up your recovery and reduce the risk of blood clots.

Your healthcare team will also monitor your vaginal bleeding (lochia), a normal part of recovery. This bleeding can last for several weeks but should gradually lessen over time.

First Few Weeks:

The recovery process continues at home. You'll likely continue to experience vaginal bleeding and discharge and abdominal and perineal soreness.

Resting as much as possible and accepting help with household chores and baby care is important.

Long-Term Recovery:

You'll likely recover more quickly from a VBAC than a C-section. However, each woman's experience will be unique, and recovery can depend on many factors, including your overall health, complications, and the specifics of your labour and delivery.

You should be able to resume most normal activities within a few weeks, but full recovery may take several weeks to a few months.

Attending all postnatal check-ups is crucial so your obstetrician can monitor your recovery process and address any concerns you may have.

VBAC Prognosis

Success rates for VBAC vary, but some studies suggest a success rate of around 60 to 80 per cent. This means that many women who attempt a VBAC can successfully give birth vaginally. Factors affecting the likelihood of a successful VBAC include the reason for the previous C-section, the type of uterine incision from the previous C-section, and the mother's overall health, among others.

VBAC Potential Risks

While many VBACs are successful, there are potential risks:

Uterine rupture: This is when the C-section scar on the uterus opens up during labour. This is a serious complication and requires an emergency C-section. However, the overall risk is relatively low.
Emergency C-section: If complications arise during labour, an emergency C-section may be needed. Emergency C-sections carry more risks than planned C-sections.
Infection and fever: VBAC and repeat C-sections risk infection and fever, but the risk is generally higher with C-sections.
Blood transfusion and hysterectomy: There is a small risk of complications that could require a blood transfusion or a hysterectomy, but these are rare.
Neonatal morbidity: There is a slight increase in neonatal morbidity risk with VBAC compared to planned repeat caesarean, but the overall risk remains low.

Each woman needs to discuss these risks with her obstetrician in the context of her health history to make the most informed decision possible about her delivery method.

Tips When Considering VBAC

Education: Learn as much as possible about VBAC, repeat C-sections, and childbirth. The more knowledge you have, the better prepared you will be to make decisions about your care.
Consult Your Obstetrician: Discuss your desire for a VBAC with your obstetrician. They can assess your health circumstances, your pregnancy, and the type of uterine scar you have from your previous C-section to help determine whether VBAC may be a good option for you.
Consider Your Reasons: Think about why you want to try for a VBAC. Some women want to avoid surgery, while others want to experience vaginal delivery. Understanding your reasons can help you weigh the benefits and risks.
Risk Assessment: Every form of childbirth carries potential risks. Have a detailed discussion with your obstetrician about the possible risks associated with VBAC and a repeat C-section so that you can make an informed decision.
Emotional Support: Pregnancy and childbirth can be emotional experiences. Ensure you have a good support system, including a partner, family, friends, a doula, or a support group.
Be Flexible: Understand that labour and delivery often go differently than planned. You can plan for a VBAC and need a C-section, or vice versa. It's important to be flexible and focused on the ultimate goal: a healthy baby and mother.
Prepare a Birth Plan: While flexible, having a birth plan in place can still be helpful. This can outline your preferences for various aspects of labour and delivery, including pain management and immediate postnatal care.
Hospital Selection: Ensure that the hospital where you plan to deliver is equipped to handle an emergency C-section if necessary.

Remember, every woman and every pregnancy is unique, so what works best for one person may not be the best choice for another. Working closely with your obstetrician is essential to make the right decisions for you and your baby.

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