Vaginal birth after C-section (VBAC): Risks and complications

Just because you have undergone a Cesarean section in the past, it does not mean a normal spontaneous vaginal delivery is no longer a possibility.

About 3 to 4 out of 5 women who have given birth via C-section can successfully give birth through vaginal delivery.

But why do some women prefer normal delivery? One big consideration is the shorter recovery period. Some also want to be more participative in the birthing process. 

Moreover, normal deliveries are more affordable and less risky than C-section surgeries. Vaginal deliveries after cesareans are a good option for those who want larger families, as C-sections are not advised to be done more than three consecutive times. 

But there is no set limit for the number of C-sections. What’s important to note is that the risk of complications increases with each surgery.

How would you know if vaginal birth after cesarean is for you? What is a vaginal birth after a cesarean? Let’s define and explore VBAC pregnancy.

What is VBAC?

What is a vaginal birth after a cesarean? Vaginal birth after cesarean (VBAC) is the term for giving birth naturally via your vagina after having previously undergone a cesarean section (C-section). 

Criteria for VBAC

To determine if VBAC birth is a viable option for you, make sure you meet the following criteria for VBAC:

• You must not have had more than two low transverse cesarean deliveries
• Must not have sustained any uterine scars during past deliveries.
• You must not have a history of uterine anomalies or ruptures.

Your doctor and medical staff must be prepared to closely monitor your VBAC delivery while being prepared to perform an emergency C-section if needed. 

You need to consider if you are uncertain if VBAC birth (Vaginal Birth After C-section) is the right choice for your next delivery.

• You no longer have the condition that prompted the C-section in the past, such as cephalopelvic disproportion
• Your medical history is free from any serious problems
• Baby's presentation in your womb is head down
• Baby's of a normal size based on the age of gestation

Is it safe to have a VBAC pregnancy?

It is anticipated that the stress of labor would cause your uterus to rupture along the scar left by a surgical incision to your uterus. 

According to the American Pregnancy Association, however, published evidence indicates that 60% to 80% of women who had a cesarean birth gave birth via VBAC delivery in their following pregnancies. 

This statistic is supported by another one from the National Institute of Child Health and Human Development, which showed that approximately 75% of VBAC pregnancy are successful.

What are the possible risks and complications of VBAC delivery?

The American College of Obstetricians and Gynecologists (ACOG) claims that VBAC delivery is safer than a repeat cesarean. But there's no denying it is accompanied by its own risks and possible complications.

The biggest fear of healthcare providers is the risk of uterine rupture. This condition occurs in about 1 in 500 women who give birth vaginally, particularly common in those whose labor had to be induced. 

According to ACOG, there is a 0.9% chance, or little less than 1 in 100, of a ruptured uterus following a prior C-section with a horizontal (transverse) cut.

Based on information from Cleveland Clinic, when your uterine ruptures, you are at risk for:

• Blood clots
• Blood loss
• Infection
• Hysterectomy
• Bladder damage

Does the incision type affect your risk of uterine rupture?

• Low transverse incisions are associated with the lowest risk of uterine rupture. Here, the lower, thinner part of your uterus is horizontally sliced.
• Low vertical incisions have a higher risk of rupture than low transverse incisions. This vertical cut is made in the lower, thinner part of the uterus.
• A high vertical incision in the uterus's upper portion carries the most risk. This form of the incision may occasionally be utilized to deliver premature babies.

Take note of these possible risks if you are considering a repeat C-section instead of VBAC delivery.

Here is a brief comparison on C-section and VBAC delivery to make your decision a bit easier.

• It is accompanied by the usual risks of routine surgeries
• A prolonged hospital stay of about 4 to 5 days, barring any complications
• Possible infection to uterus, bladder, or surgical incision
• Injury to the bladder, bowel, or other nearby organs is possible
• Possible persistent pain and discomfort of the surgical incision
• Minimal risk of infant respiratory problems
• Increasing risk of future C-section deliveries

Benefits of VBAC delivery 

VBAC birth has several benefits over C-sections, including:

• Faster recovery
• No abdominal surgery
• Reduced blood loss
• Vaginal delivery helps to clean the baby's lungs as it passes through the birth canal. Your newborn baby's breathing after birth will be made easier by this.
• Newborns receive helpful microorganisms during their transit through the birth canal may strengthen their immune systems.
• Reduced or prevented dangers associated with a C-section

Here are the possible considerations for VBAC delivery

• There is less than a 1% chance of uterine rupture.
• In cases of uterine rupture, possible complications include heavy bleeding, bladder injury, infection, blood clots, and emergency hysterectomy.
• If an emergency C-section is needed, the risk of infection is higher.
• 2-day hospital stay
• Possible tearing or episiotomy to widen the birth canal
• Vaginal pain or discomfort for a short period of time
• Once baby passes through birth canal, his lungs usually clear

We hope this information will help you make your decision easier. Make sure to constantly communicate with your OB-Gynecologist and voice out any concerns you may have to have a worry-free and healthy pregnancy.

Consult your doctor about VBAC delivery

With your healthcare provider’s guidance, you should go through your specific medical history, current pregnancy status, and the reason for your previous C-section.

You increase your chance of VBAC delivery if you:

• Possess a maximum of two C-section deliveries through low transverse incisions.
• Have no more uterine scars or abnormalities.
• Have never experienced a uterine rupture.
• Had a successful VBAC without issues like a burst uterus, you have a higher probability of having successful future vaginal deliveries.

If you're considering a VBAC delivery, discuss the possibilities, your concerns, and your hopes with your doctor as soon as possible. Make sure your doctor is well-versed in your medical background, particularly any records of previous uterine operations, including C-sections. 

Give birth to your child in a facility that is equipped to handle an emergency C-section as well. Continue discussing the benefits and drawbacks of a VBAC throughout your pregnancy, especially if any risk factors emerge.

Additional information from Margaux Dolores

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