If you’ve had a cesarean delivery, you’re not alone in your journey. If you’re considering a vaginal birth after cesarean (VBAC), it’s encouraging to know that about 90% of women with a prior cesarean are eligible for this option. Research shows that 60-80% of women who attempt VBAC can successfully give birth vaginally. By reviewing the following information and discussing your options with a healthcare provider, you can make an informed choice about pursuing VBAC.
The Risks of Uterine Rupture with VBAC
The primary concern for women considering VBAC is the risk of uterine rupture during a vaginal delivery. The American College of Obstetricians and Gynecologists (ACOG) states that if your previous cesarean was performed using a low transverse incision, the risk of uterine rupture during a vaginal birth is between 0.2% and 1.5%—roughly 1 in 500. Some studies indicate that the risk may increase in cases of labor induction or augmentation, so it’s essential to discuss potential complications with your healthcare provider. Recently, ACOG affirmed that VBAC is often safer than opting for a repeat cesarean, even for those with multiple previous cesareans.
If your past cesarean was due to specific conditions, it may be worth discussing their relevance with your healthcare provider. For instance, if your previous cesarean was due to dystocia (a prolonged and difficult labor), many women have successfully delivered vaginally in subsequent pregnancies, even with larger babies. ACOG notes that no substantial evidence supports that a baby over 8 ¾ lbs must be delivered via cesarean. Techniques such as squatting can help widen the pelvic outlet, facilitating the birth of a larger baby.
Historically, women with a history of genital herpes often underwent cesareans to prevent transmission during delivery. However, ACOG now recommends that unless visible lesions are present at delivery, vaginal birth is a viable option. For cases of fetal distress, while many women might lean towards cesarean, fetal heart rate monitoring can be effectively employed during VBAC to assess the baby’s well-being.
Criteria for VBAC Eligibility
To be considered for a VBAC, certain criteria must be met:
- No more than two low transverse cesarean deliveries.
- Absence of additional uterine scars, anomalies, or previous ruptures.
- Your healthcare provider should be prepared to monitor labor and take necessary action if a cesarean becomes warranted.
- Your birth facility should have personnel available on weekends and evenings for any urgent needs.
Ideal Candidates for VBAC
You may be a good candidate for VBAC if:
- The reason for your previous cesarean is not applicable to this pregnancy.
- You have no significant medical issues.
- Your baby is of normal size and in a head-down position.
Comparing Repeat Cesarean and VBAC
| Repeat Cesarean | VBAC |
|---|---|
| Risks associated with surgical procedures | Less than 1% chance of uterine rupture; if it occurs, there are risks of blood loss, hysterectomy, bladder damage, infection, and blood clots |
| Hospital stay of about 4 days | Hospital stay of roughly 2 days |
| Risk of infection in the uterus, bladder, or incision site | Infection risk increases if vaginal delivery is attempted but leads to cesarean |
| Potential injury to adjacent organs | Possibility of tearing or requiring an episiotomy |
| Risk of blood clots post-surgery | Ongoing pain and discomfort around the incision site |
| Small chance of newborn respiratory problems | Baby’s lungs clear during passage through the birth canal |
Considering future pregnancies is crucial, as multiple cesareans can increase surgical complication risks.
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In summary, VBAC can be a viable option for many women who have previously undergone cesarean deliveries. By understanding the risks and discussing your unique circumstances with a healthcare provider, you can make an informed decision that aligns with your birth preferences.