VBAC (Vaginal Birth After C-Section)

Many women are candidates for vaginal birth after cesarean (VBAC). In fact, research on women who attempt a trial of labor after cesarean (TOLAC) shows that about 60 to 80 percent have a successful vaginal delivery. Still, the choice to pursue VBAC or schedule a repeat C-section can be difficult . A cesarean can be emotionally difficult or traumatic for fathers/partners. After a long and difficult birth that ended with a cesarean, partners may feel that a repeat cesarean would be safer than planning a VBAC. Some partners may not be sure they can meet the challenge of another possibly long birth.

Why consider VBAC?

Compared with having another C-section, a vaginal delivery involves no surgery, none of the possible complications of surgery, a shorter hospital stay and a quicker return to normal daily activities. VBAC might also be appealing if you want to experience vaginal childbirth. It's important to consider future pregnancies, too. If you're planning for more pregnancies, VBAC might help you avoid the risks of multiple cesarean deliveries, such as placental problems. which is an increased risk of fetal distress and can lead to pregnancy loss.

What are the risks of VBAC?

While VBAC is associated with fewer complications than an elective repeat C-section, a failed trial of labor after a C-section is associated with more complications, including, rarely, a uterine rupture. During a uterine rupture, the uterus tears open. An emergency C-section is needed to prevent complications, such as heavy bleeding for the mother and life-threatening injury to the baby. Sometimes, the uterus might need to be removed (hysterectomy) to stop the bleeding. If your uterus is removed, you won't be able to get pregnant again.

Who's eligible for VBAC?

VBAC eligibility depends on many factors. For example:

Have you had previous vaginal deliveries? A vaginal delivery at least once before or after your prior C-section increases the probability of a successful VBAC. What type of uterine incision was used for the prior C-section? Most C-sections use a low transverse incision. Women who have had a low transverse or low vertical incision are usually VBAC candidates. If you've had a prior high vertical (classical) incision, VBAC isn't recommended because of the risk of uterine rupture. How many C-sections have you had? Some health care providers won't offer VBAC if you have had more than two prior C-sections.When was your last C-section? The risk of uterine rupture is higher if you attempt VBAC less than 18 months after having a C-section . Do you have any health concerns that might affect a vaginal delivery? A C-section might be recommended if you have placental problems, your baby is in an abnormal position, or you're carrying triplets or higher order multiples. Where will you deliver the baby? Plan to deliver at a facility equipped to handle an emergency C-section. A home delivery isn't appropriate for VBAC. Will you need to be induced? Having labor induced or augmented decreases the likelihood of a successful VBAC. Have you ever had a uterine rupture? If so, you're not a candidate for VBAC.

How does labor and delivery during VBAC differ from labor and delivery during a routine vaginal birth?

If you choose VBAC, when you go into labor you'll follow a process similar to that used for any vaginal delivery. However, your health care provider will likely recommend continuous monitoring of your baby's heart rate and be prepared to do a repeat C-section if needed.

What other advice do you offer women who are considering VBAC?

If you're considering VBAC, discuss the option, your concerns and expectations with your health care provider early in pregnancy. Make sure he or she has your complete medical history, including records of your previous C-section and any other uterine procedures. Your health care provider might calculate the likelihood that you'll have a successful VBAC. It's important to continue discussing the risks and benefits of VBAC throughout pregnancy, especially if certain risk factors arise.

Find out about the VBAC policy at the facility where you'll deliver your baby, but try to stay flexible. The circumstances of your labor could make VBAC a clear choice or, after counseling, you and your health care provider might decide that a repeat C-section would be best after all.

Each partner is different and needs to prepare in his or her own way for the coming birth. Partners should take the time to talk about the prior cesarean and define for themselves how they can best support their partners for a VBAC.

What advantages do you see for your partner, yourself, and your family if you plan a VBAC?What are the disadvantages? What issues do both of you agree and disagree on? Can you think of ways of working through these issues? Have you thought about accompanying your partner to a prenatal appointment? Would you consider going with her to a VBAC support group? Supporting a woman in childbirth is hard work. Are you worried you won’t be able to give her what she needs? .

How do you feel about advocating for your partner during labor? Have you thought about having a doula that can guide and support you both during labor and birth? What information or resources do you need to make you feel comfortable about planning a VBAC? You feel strongly that a scheduled repeat cesarean is the safest and easiest way to have this baby. Can you understand why your partner feels strongly about planning a VBAC?

An unexpected cesarean can be emotionally difficult for both mothers and fathers. Providing support for a mother who is planning a VBAC can be challenging. As couples think about their next birth,  fathers/partners should take the time to share their feelings, their concerns, and their differences so that they can provide the best support they can in pregnancy and birth.

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