• Athina Vandevoort

VBAC: Yes or No?

Updated: Apr 26

Many women have a good understanding of what they’d like their (first) birth experience to look like. Everyone wants a healthy baby and an uncomplicated labor that doesn’t last too long. But what if a complication occurs and you need to have an emergency cesarean? Or what about the women who are pressured into a c-section by their practitioner (because it is more convenient for his schedule, because it is supposedly safer…)?

A c-section is a surgery where the woman is brought under local (spinal epidural) or general anesthesia. An incision is made in the abdomen and the baby is delivered through this incision. Indications for an emergency c-section include:

· fetal distress: your baby’s heartbeat consistently goes below what is considered as a normal fetal heartrate during contractions, which could indicate he is experiencing the process of labor as too stressful

· failure to progress: although active labor is established and contractions are strong and regular, there is no dilation happening. Labor is considered as not progressing. NOTE: dilation alone is not a good indicator of progress. Other factors have to be considered when assessing progress. Failure to progress can be caused by malpositioning of the baby, which can sometimes be corrected during labor.

· Maternal complications: when there is a pre-existing medical complication, a woman might be given the option to have a ‘trial of labor’ and wil be closely monitored. Examples of these complications are placenta praevia (where the placenta might be covering part of the exit), pre-eclampsia (where the mother’s blood pressure has to be monitored), diabetes gravidarum etc.

If you’ve had a cesarean before, and you will attempt a vaginal birth with your next pregnancy, it is called a VBAC (vaginal birth after cesarean). Ideally, you only had one cesarean, but some healthcare practitioners will still let women attempt a VBAC after two cesareans. Since the woman has not given birth vaginally before, the labor pattern and process will resemble that of a first-birthing mother. A VBAC labor is, contrary to a second vaginal birth, usually not shorter than the first one. The biggest concern for a VBAC, and the reason why some doctors shy away from it, is that the uterine scar will rupture under the pressure of the contractions. While it is always important to be cautious about possible complications, if you feel strongly about not having another cesarean, there is often no reason to be denied a vaginal birth.

The risk of a uterine rupture during a VBAC is 0.5%. The first symptom of a rupture is pain that doesn’t go away when the contraction ends. In the case of a rupture, things need to go fast. This means doctors will advise against a homebirth for a VBAC, as they want to monitor you closely. If you decide to have an epidural during your labor; try to wait until you are in active labor ( from 6 cm dilation onwards). This gives you a good idea of what contractions feel like. In case of pain returning despite your epidural, contact the nurse immediately.

When a VBAC is successful, it has less complications than a second cesarean. This means it is actually a safer option than going for another cesarean. The success rate for a first VBAC is 72-75%, where the consecutive VBAC’s will be 85-90%.

Having another cesarean the second time around is called a repeat elective cesarean section (ERCS). The medical world has come a long way and has perfected its interventions, but it remains surgery with its own complications:

· Some doctors may advise having an ERCS a few weeks before your due date, to prevent you will go into labor and they have to rush you off to an emergency c-section, which carries more risks. It has been proven that having a cesarean before 39 weeks of pregnancy increases the risk of your baby being born and struggling with breathing, as the last few weeks help with lung development.

· Having a c-section, and every consecutive one thereafter, increases scarring tissue in your uterus. There is a higher change of your placenta implanting itself in this scar tissue during your next pregnancy. This will lead to complications that can be quite severe, as your placenta won’t be able to expel itself fully. Excessive bleeding and possible removal of the uterus are some possible complications with placenta accrete.

· The risk of placenta praevia is also slightly higher after a cesarean. This is when the placenta is implanted low in the uterus, and possibly fully or partly covering the exit.

· Every surgery will cause adhesions, which is scar tissue formed and ‘sticking’ together. These adhesions can cause pain, inflammation, and complications with subsequent attempts of getting pregnant or giving birth.

Some women will still choose a cesarean after knowing these facts. Truth is, we live in a very developed medical world where surgery does carry some risks, but the chances of complications are still very small. If you feel most comfortable with having a repeat cesarean, then that is your choice. It is your birth and you are the one who has to feel empowered and in control.

If you do want a VBAC for your next pregnancy and don’t know where to begin, here are some tips:

· Find a doctor who supports a VBAC and has much experience with one.

· Engage in antenatal classes or employ a doula to help you cope with contractions. Some doulas specialize in baby (mal)positioning: look for someone who can help you make sure baby is in the most optimal position this time around, which will lead to shorter and more efficient labor

· Visit a chiropractor or physiotherapist who can help make sure there are no blockades that disable baby to descend

· Be kind to yourself: your body is amazing, regardless of how your baby came into this world.