VBAC Guide by Dr Ryan Lee: What It is, Benefits & Risks

What is VBAC?

Vaginal birth after caesarean, or VBAC, is a term used for a normal vaginal delivery of a baby following a previous caesarean section (C-section). A vaginal birth can either happen by normal delivery or be assisted using medical tools.

This method of delivery carries relatively little risk for mothers who have previously had a caesarean section. VBAC can be offered to mothers as an alternative to a caesarean section if the baby is in a head-down position, with the exception of a low-lying placenta. The chances of success are higher if there has been a previous successful VBAC.

Is VBAC a good childbirth method?

Mothers can choose vaginal birth, as this type of childbirth offers several benefits to the mother and the babies compared to a C-section delivery.

• For mothers

  • Choosing vaginal birth allows mothers to avoid surgical intervention, which typically results in less post-delivery discomfort, a faster recovery, and eliminates concerns about surgical scarring. 

  • Natural childbirth also reduces the risk of surgical complications, such as heavy bleeding or infections. 

  • This approach can be particularly beneficial to mothers planning for future pregnancies, as multiple C-sections may increase risks to both mother and baby in subsequent deliveries.

• For the baby

  • During vaginal delivery, the baby benefits from passing through the birth canal (vagina). This  process helps to clear fluid from their lungs, helping them to adapt to breathing air after birth. 

  • Additionally, babies born through the birth canal are able to have skin-to-skin contact with their mothers sooner.

• Personal experience

  • You may choose VBAC if you want to experience natural childbirth after consulting your doctor to determine if you are suitable for VBAC.

  • The healthcare team will understand your personal preference because many women find the experience of vaginal birth meaningful and empowering. 

VBAC has a success rate between 72% and 75% for mothers attempting their first vaginal birth after a caesarean section. This rate increases to 85-90% if the mother has taken VBAC previously, making vaginal birth a good alternative childbirth method.

However, it’s important for mothers to discuss their condition with the healthcare team to determine if VBAC is a viable option for them.

Vaginal birth after C-section consideration

While the final say to attempt a VBAC is up to the mother and partner's choice, it's still important to consult your healthcare provider. They will consider your prior pregnancies and medical history to guide you in making an informed decision. 

Several considerations will help determine your suitability for VBAC, including:

1) Previous caesarean section

The type of previous caesarean section performed during your previous birth can affect the decision to greenlight a vaginal birth. There are two types of caesarean incisions:

• Classical C-section

  • This means a  vertical incision in the upper part of the womb. Mothers who had this kind of incision are not to attempt vaginal birth, as there is a high risk of uterine rupture.

• Lower segment C-section

  • This refers to a horizontal incision on the lower part of the womb. This type of cut had a lower risk of uterine rupture, and mothers with this type of incision may participate in VBAC.

2) Reason for the previous caesarean section

If the reason for the previous caesarean section is due to cephalopelvic disproportion (CPD), where the pelvis is too small to allow the passage of the baby’s head, VBAC may not be suitable.

3) Complications during the previous caesarean section

If the previous caesarean section was complicated by unexpected tears in the uterus, your healthcare provider may advise a repeat caesarean section in the subsequent pregnancy.

4) Current pregnancy

Several conditions during the current pregnancy, such as a low-lying placenta or a breech presentation (where the baby is not in a head-down position), may make VBAC unsuitable.

5) Other medical conditions

Certain maternal health conditions, including heart disease or severe hypertension, could make it difficult for mothers to endure the physical stress of a vaginal delivery. 

It's also important to note that previous surgical procedures, particularly operations to remove fibroids, may increase the risk of complications and uterine rupture during labour, as they could affect the strength of the uterine wall.

Need help with choosing the appropriate childbirth methods? Reach out to our obstetricians at Thomson Women’s Clinic to explore your birthing options, including the advantages and risks of each option. Request an appointment with us today.

The risks of VBAC

The primary risk factor with a VBAC attempt is uterine rupture from your previous caesarean procedure. While the incidence of scar rupture is rare, there are other risks that can arise, such as blood loss or a need for surgical removal of the womb (hysterectomy).

You will be advised to come to the healthcare facility early once you start having regular contractions or when your waters break. So the healthcare team can monitor your baby’s heartbeat during labour, as any change in the heartbeat can be a sign of uterine rupture. 

In this scenario, the vaginal birth will be aborted, and an emergency C-section section will be performed. However, mothers don't need to worry, as this risk largely depends on your health history and the specific circumstances of each pregnancy.

FAQ

Is vaginal birth possible after a C-section?

Yes, vaginal birth after caesarean section (VBAC) is possible, particularly if you've had only one C-section delivery with a horizontal cut on the lower part of the womb. However, suitability depends on various factors, such as the current pregnancy condition and overall health.

How soon can you give birth after a C-section?

After a previous C-section, mothers should wait 12 to 18 months before conceiving again to ensure full recovery. It is important to make sure that the C-section scar has fully healed if you are considering a vaginal birth in your next pregnancy, as this significantly reduces the risk of uterine rupture.

What is the success rate of VBAC induction?

A VBAC childbirth has a success rate of 72-75% for first attempts after a caesarean section. This rate increases to 85-90% if the mother has had a history of successful VBAC.

Why doesn't the healthcare team recommend VBAC?

Your healthcare provider may not recommend VBAC if you have several conditions, such as:

• Have had a classical C-section (vertical incision in the upper part of the womb) in a previous delivery.

• If the previous caesarean was due to cephalopelvic disproportion (CPD), where the pelvis is too small to allow the baby's head to pass through.

• If there were complications like unexpected tears in the uterus during the previous caesarean section

• Current pregnancies with conditions such as a low-lying placenta or breech presentation (baby not in head-down position).

• Certain health conditions, such as heart disease or severe hypertension, that make it difficult to endure the physical stress of vaginal delivery.

• Mother has had previous surgical procedures, particularly operations to remove fibroids, which may affect the strength of the uterine wall and increase the risk of complications during labour.

What is more painful, a C-section or a natural birth?

Both C-section delivery and vaginal delivery can be painful, but since a caesarean birth involves abdominal surgery, the pain is usually more intense. During the recovery period, mothers often require more pain relief than those who undergo vaginal delivery.

What is the disadvantage of VBAC?

The disadvantage of VBAC is the uncommon risk of uterine rupture from your previous caesarean procedure, the possibility of blood loss, or the need for a hysterectomy. While these risks are rare, they can be life-threatening, making appropriate medical care and monitoring important during VBAC.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, request an appointment with our specialists at Thomson Medical today.