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 assisted using medical tools.

This childbirth method carries a relatively small risk for a mother who had previously undergone a C-section. A VBAC may be offered as an alternative to a C-section to a mother if the baby is in a head-down position, excluding low-lying placentas. The chance of success is higher if there was 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.

• For mothers

  • Choosing vaginal birth allow mothers to avoid surgical intervention, which typically results in less post-delivery discomfort, a quicker recovery period, and reduced concerns about surgical scarring. 

  • Vaginal 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 wish to experience natural childbirth after consulting your doctor to determine if you are suitable for VBAC.

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

VBAC has a success rate between 72-75% 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 your condition with the healthcare team to determine if VBAC is a viable option for you.

VBAC consideration

While the final decision to attempt a VBAC is up to the mother and partner's choice, it's still important to consult with 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

  • Refers to a horizontal incision on the lower part of the womb. This type of cut has 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 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 with VBAC 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 labour ward 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 will be performed.

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.

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

Both C-section 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.