Vaginal Birth After Cesarean

What is VBAC?

Vaginal Birth After Cesarean (VBAC) is defined as vaginally giving birth after having one or more cesareans (also called c-sections). It was previously thought that once a woman has a cesarean delivery, all following deliveries would have to be cesarean. There is evidence that this is not necessarily true and VBAC is no longer considered high risk. According to the American College of Obstetricians and Gynecologists (ACOG), 50 to 80 percent of women who choose vaginal delivery after cesarean can do so safely. Even women who have had more than one cesarean or are carrying twins have a good chance for a successful vaginal delivery.

Why consider VBAC?

There are several reasons to consider VBAC, such as:

• Less risk and shorter recovery - A vaginal delivery is associated with fewer complications and involves less risk than a cesarean delivery. With vaginal births there is a lower risk of infection, as there is no incision. In addition, you will not have an increased risk of side effects from medicines given for pain after surgery, there are shorter hospital stays and recovery times, and a faster return to normal activities. There is also less postpartum pain associated with a vaginal birth as compared to a cesarean, which is similar to major abdominal surgery.

• Benefits to your baby - Contractions are thought to be beneficial to the baby. Upon delivery, the contractions massage and stimulate the baby to help prepare for birth and the first breath outside the uterus.

• Personal desire to be more involved with this birth - Some mothers may feel as though they have missed out by having a previous cesarean due to the anesthetic and lack of feeling as though they had an active role during labor. Or, some mothers may feel disappointed after having gone through a difficult labor in which they hoped to deliver vaginally but ultimately required an emergency cesarean. In other situations, the father or support person may not have been permitted in the operating room during the cesarean delivery. This may have caused stress and negative feelings for both parents, which they would rather not repeat with this birth.

Factors that affect candidacy for VBAC

The type of incision from a previous cesarean birth and the kind of scar that formed play a large part in determining whether you can deliver vaginally after cesarean. There are three types of incisions used during cesarean births:

Low transverse - a horizontal incision across the lower, thinner section of the abdomen. This is the preferred incision due to stronger healing and less complications with VBAC. Ninety-five percent of women who have cesareans today have this type of incision.

Low vertical - a vertical incision in the low, thin section of the abdomen. Complications from this incision are not well defined. It is advised that a patient with this type of incision seek medical advice for VBAC eligibility.

Classical high vertical - this vertical cut high in the abdomen was formerly the most common type of incision. However, it is no longer as common because there is a high risk that the scar will rupture during VBAC. Uterine bleeding from the ruptured scar poses a serious threat to the baby and mother. Therefore, patients with this incision may be advised not to attempt VBAC.

For VBAC, the type of incision is very important to the safety of the mother and child and should be examined thoroughly. The type of incision can not be determined from the type of abdominal scar. You will need to consult your doctor who will check your medical records to confirm the type of incision that you had during a previous cesarean birth. Your doctor will also review your personal medical history to try to avoid all unnecessary risks if VBAC will be attempted.

The reason why a cesarean was necessary for previous births also affects a person's candidacy for VBAC. VBAC may be possible if a cesarean birth was performed because of a condition that isn't likely to repeat itself such as fetal distress, premature separation of the placenta, dangerous position of the placenta, infection, breech or toxemia.

VBAC may not be possible if a cesarean birth was performed because of a medical problem (high blood pressure or diabetes) or an uncorrectable problem such as cephalopelvic disproportion in which the baby's head is too large for the woman's pelvis.

What can I do?

There are several things you can do to help increase the possibility of a VBAC.

1. Educate yourself both before and during pregnancy. A previous difficult experience with attempted vaginal delivery may arouse fear and uncertainty toward another attempt. Being informed will enable you to make the most appropriate decision for you and your baby. Educational books, audio tapes and video tapes are available to you. Literature is also available regarding local hospitals and health care providers who are experienced in VBAC. Researching and interviewing as many of these health care providers as possible will help you locate the best avenue of care for your personal situation. Being informed will enable you to make the most appropriate decision for you and your baby.

2. Create and maintain a healthy environment by surrounding yourself with supportive people. Encouragement may be found through local birthing support groups (vaginal or cesarean) or childbirth classes. Both may prove to be valuable in eliminating any negative feelings from previous cesarean births and creating a positive outlook for the upcoming birth. They may also help prepare you for this new experience and soothe any fears you may have while making your baby's transition into this world as easy and healthy as possible.

3. Consult your Obstetrical (OB) Care Provider. As with any medical decision you make, your OB provider should play a key part. If you are considering VBAC, consult with your OB provider early during your pregnancy to discuss the benefits and potential risks of VBAC. Your OB provider can carefully review your medical history as well as all possible risk factors. He or she will explain all options to you and help you make the best decision for you and your baby.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health This document was last reviewed on: 9/9/2002