Vaginal Birth After C-Section (VBAC)
The old phrase "once a C-section always a C-section" is no longer true. In the past, the belief was that if a woman had delivered one baby by C-section, all other children had to be delivered the same way. Today many women can have vaginal deliveries after a previous C-section delivery. This is referred to as a vaginal birth after cesarean (VBAC).
Candidates For VBAC
According to the American College of Obstetricians and Gynecologists (ACOG), the following women are candidates for VBAC:
- If the woman has had one or two prior low-transverse (commonly referred to as "bikini incision") C-section deliveries
- If the woman has no other uterine scars or ruptures, whether from previous C-sections or other surgeries
- If the woman has a pelvis large enough to adequately have the baby
ACOG has specifically stated that whenever a woman is planning a VBAC delivery, there should be an appropriate medical team available, including an anesthesiologist, throughout the active labor so that an emergency C-section may be done if necessary. Smaller hospitals may not have the resources to monitor a VBAC delivery or to provide an emergency c-section for VBAC situations, and VBAC delivery may not be possible.
Women Who Should NOT Have VBAC
One of the main concerns with having a vaginal delivery after a C-section is the potential rupture of the uterus, which could be harmful to you and the baby. Therefore, ACOG has made recommendations for women who should not try a VBAC delivery. These women include:
- Women with a high vertical (or classical, T-shaped) incision
- Women with a small pelvis or delivering a large baby - it may not be safe for the baby to pass through the pelvis (fig. 1)
- Those with a medical problem or obstetric condition, such as placenta previa or abrubtio placenta
- Women delivering in a hospital without an available medical team for VBAC monitoring and emergency C-section
The Benefits of VBAC
Statistically, about 60-80% of women who try VBAC are able to deliver vaginally. If you are considered a candidate for VBAC, there are some advantages to having a vaginal delivery over a C-section. Some of these include:
- Shorter hospitalization
- No abdominal surgery
- Lower risk for blood transfusion and infection
- Overall faster recovery
The most serious risk with VBAC is rupture of the uterus. The risk of rupture of the uterus in low transverse is about 1%, whereas the risk of rupture of the uterus in previous classical C-section is 5-8%. No labor and delivery is without risk. Having a C-section has its own risks, such as needing a blood transfusion, postpartum fevers, and a longer hospital stay.
The Final Decision Is Yours
The key to making a decision about VBAC is to discuss with your doctor the risks and benefits for both you and your baby. The circumstances are different for everyone and it is important to seek guidance from your doctor that is specific to you.
Ultimately, the decision is yours. The more information and understanding you have about VBAC, the easier it will be to make a decision.
Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of
Pennsylvania School of Medicine. Review provided by VeriMed Healthcare
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