Vaginal Birth after Caesarean
If you have had a previous caesarean birth and are pregnant again, you will face a few decisions. You will also be the lucky recipient of a variety of opinions about how you should birth this baby. One of your options is to plan a VBAC (vaginal birth after caesarean). When it comes to VBAC, there is a lot of information to absorb and decipher. This information can be understandably confusing, frustrating and even frightening. Ultimately the choice is yours, to be made in consultation with your care provider and full knowledge of the risks and benefits involved.
Can I plan a VBAC?
Most women can plan on vaginal birth after a caesarean section. However, whether you have the choice between vaginal birth and a repeat caesarean section within the maternity services available to you is a different story. If you choose to plan a vaginal birth and your local services don’t support your plans, you may need to find maternity services that do. When you do find a service that supports your plans, please discuss any specific wishes you may have with your care provider. Research is currently underway examining the safety of waterbirth after caesarean sections. Until there is substantial evidence, your care provider will support you so long as he or she feels safe to do so.
Is it safe?
Whether it is safe to plan a VBAC will depend on:
- Why you had your previous caesarean,
- How long ago your caesarean was,
- If you have had a vaginal birth since your caesarean,
- The support of your care provider,
- If your intended birth facility has a written policy and procedure to support VBAC,
- Your current health status (your risk factors),
- Your baby’s health (baby’s risk factors),
- How many weeks pregnant you are,
- Your baby’s presentation.
- The number of caesarean sections you’ve had.
What’s the VBAC success rate?
Current research indicates that you have a higher chance of success if (36, 37):
- You have previously had a vaginal birth
- Your baby is expected to less than 4000g
- Your labour starts spontaneously
- You intend to give birth in a public hospital
Recent research has found differences between elective repeat caesarean section (ERCS) and VBAC in the following areas (37):
- Uterine rupture (VBAC 0.5% vs ERCS 0.02%)
- Fever in labour (VBAC 6.5% vs ERCS 7.2%)
- Woman dying during birth (VBAC 0.004% vs ERCS 0.013%)
Studies found no difference between VBAC and repeat caesarean when it came to:
- chance of hysterectomy,
- requiring a blood transfusion,
- perinatal mental health,
- satisfaction with the birth experience
- low APGAR scores at birth (indicators of baby’s need for resuscitation (36)
Labour practices vary throughout the world; however, ultimately, you should be asked to consent to any recommended intervention. These interventions include the siting of an IV cannula in your arm and continuous fetal monitoring. We will observe expected progress more strictly, and suggest medical interventions suggested than women without a caesarean history.
Vaginal birth after a previous caesarean is safest when your labour starts spontaneously (36, 37).
However, nature doesn’t always comply, and it may be that induction may be less risky for you or baby than staying pregnant. Induction of labour involves risk. This risk applies to all women. Women with a scar on their uterus (through caesarean or other uterine surgery) have increased odds of uterine rupture because the integrity of the uterine muscle is unknown.
If you wish to manage your labour outside of recommendations, your care providers may request your signature on a care variation form.
The risk of uterine rupture is:
- Spontaneous labour 0.19%
- Induction of labour at term 1.5%
- Induction of labour post-dates 3.2%
The degree of risk involved will depend on how your labour is induced. Please discuss this risk and risk management strategies with your care provider.
The Queensland Centre for Mothers and Babies is an organization that provides extensive information for expectant mothers. Guidelines covering the fact and fiction of VBAC can be found here.
Nikki-Lee Rossiter (BMid), Registered Midwife/Dr Janelle McAlpine (PhD), Clinical Midwife
Photo by Troyan, used under licence from Shutterstock.com