Have you had a C-section? Are you thinking about how to give birth next time?
For many years it was assumed that once a woman had a C-section all future babies would also be delivered this way. However, this is not always the case. Whether you decide to have a Vaginal Birth After a Caesarean (VBAC) or a planned C-section in your future pregnancy, either option is usually safe but also has different risks and benefits involved.
Every woman’s preferences and risk profiles will be different.
It is extremely important to discuss your birth options with your obstetrician, to ensure that you are making the most informed choice. When considering your options your obstetrician will ask you about your medical history & your previous pregnancies (unless this is the same obstetrician as your previous pregnancies, then they will know your history).
Your obstetrician will want to know about:
- The reason for your caesarean delivery & what happened – was it an emergency?
- The type of cut that was made in your uterus
- How you felt about your previous birth experience? (do you have any concerns?)
- Whether your current pregnancy has been straightforward or have there been problems or any complications? (read our previous blog on Caesarean Sections to learn more).
Your obstetrician will always respect your right to be involved in the decision-making regarding the birth of your child, and your awareness of the risks and plans for future pregnancies.
It is important that your decision involves your partner and be made earlier on in your pregnancy and of course in consultation with your obstetrician. An agreed plan will then be documented in your pregnancy file.
What are the benefits & risks of VBAC?
Benefits of a successful VBAC include:
- A vaginal birth; which may include an assisted birth
- A higher chance of an uncomplicated normal birth in future pregnancies
- When repeat elective C-section is chosen, there are risks associated with any major surgery, and all future births are likely to be by C-section. As the number of previous C-section deliveries increase, so does the risk of rare but serious complications
- A shorter recovery & shorter stay in hospital
- Less abdominal pain after birth
- Some may have personal satisfaction in achieving a vaginal birth
- Babies born vaginally have a lower risk of respiratory problems.
Risks for the mother & baby when attempting a VBAC:
- There is a chance you will need an emergency C-section during labour, which has amplified risks of bleeding and infection compared to a planned C-section
- Uterine scar rupture. This can result in serious problems for the baby (brain injury or even death) or for you (severe bleeding, including the small risk of hysterectomy)
- The risk of your baby dying or being brain damaged in you chose a VBAC is very small (two in 1000 women). This is low however is it slightly higher than if oyu had a repeat C-section (one in 1000).
However, this needs to be weighed up against the risks and benefits of a planned C-section.
It can be challenging to explain and comprehend the risk of complications which occur rarely, but can have severe consequences if they occur.
When it’s not suitable for a VBAC
- You have had three or more previous C-Section deliveries
- Your uterus has ruptured previously
- You have a high uterine incision
- You have had a previous surgery to your uterus (removal of fibroids)
- You have other pregnancy complications that require a C-section delivery
Factors affecting success of VBAC
Factors favouring success include:
- Previous vaginal birth
- Previous successful VBAC
- Spontaneous onset of labour
- Uncomplicated pregnancy without other risk factors
Factors making it less likely for a successful vaginal birth include:
- You have never had a vaginal birth
- Need to have your labour induced
- Have had more than one previous C-section
- Overweight with a BMI over 30 at booking
- Have a complicated pregnancy
- Have had sloe progress in a past labour
What happens if you don’t go into labour?
If you do not go into labour by 41 weeks your obstetrician will discuss various options with you. Induction of labour does remain an option for you however, this reduces the success rate of achieving VBAC and increases the rate of uterine rupture.
How will your care during labour be different if you have a VBAC?
There will be continuous monitoring of your baby’s heartbeat once you are in established labour. The progress of your labour will be closely monitored, and if you are not making good progress a repeat C-section will be advised. You will be involved throughout your labour with the planning of your care.
It is very important to think about all of your options very carefully. Your obstetrician is there to discuss any questions that you may have. Regardless of how your next baby is born vaginally or by C-section, she wants your experience to be safe, rewarding & satisfying for you and your family. And most importantly that you and your baby are healthy!