6 min read
BY LAUREN BRENTON | ENDORSED MIDWIFE & CHILDBIRTH EDUCATOR
The saying “once a caesarean, always a caesarean” is not the case anymore! Many women have the option of a VBAC after having had a caesarean section. VBAC, which stands for Vaginal Birth After Caesarean.
It is important to acknowledge that although VBAC is a suitable option for many women who have had a past caesarean section, women should be well informed to decide on whether they would prefer an elective caesarean or a VBAC and their decision should be respected.
In this Q&A, we will address some common questions about VBAC to help you make an informed decision about your birth plan.
What is VBAC, and how does it differ from a planned Caesarean Section?
VBAC is the abbreviation for Vaginal Birth After Caesarean, which involves giving birth vaginally after having had a previous Caesarean. In contrast, a planned Caesarean is scheduled ahead of time and involves surgical delivery through an incision in the abdomen. VBAC allows for a vaginal birth if certain conditions are met, and this is what the family would like.
Who is a suitable candidate for VBAC?
Before considering whether you should have a VBAC or an elective Caesarean, it is important to consider the reason why you had a caesarean in the first incidence. Having this counselling from the doctor and/or midwife that performed the initial caesarean will help you to understand why this caesarean occurred and if you are a good candidate for VBAC. VBAC is generally considered for women who have had a previous C-section but wish to attempt a vaginal delivery in their subsequent pregnancies. However, not all women are suitable candidates.
What factors impact the success of a VBAC?
- Factors that favour a successful VBAC include:
- Having had a previous vaginal birth or previous successful VBAC
- Going into labour spontaneously
- Having an uncomplicated pregnancy
- Factors that may reduce success include:
- Having had a previous caesarean section for your labour not progressing
- Having an induction of labour
- Having less than 18 months in between births (this can increase the scar rupture risk by 2-3 fold).
- A previous Classical Caesarean Section
- The pregnancy being complicated due to fetal, placental or maternal complications
- Maternal BMI > 30
- Macrosomia (baby of 4kg or more)
- Maternal age greater than 42
- Gestational age greater than 41 weeks
- Having a short stature
- More than one previous caesarean
What are the success rates of a VBAC?
Published studies vary with the success rates of women attempting a vaginal birth after a caesarean. It is estimated from these studies that success rates are around 60-80% (RANZCOG, 2022).
What are the benefits of choosing VBAC?
Opting for VBAC can offer several advantages, including:
- Reducing the risk of complications in future pregnancies.
- Avoiding major surgery and the associated slower healing that comes with this.
- Earlier mobilisation and discharge from hospital.
- Increased satisfaction with achieving a VBAC if this is the chosen option.
What are the potential risks associated with VBAC?
While VBAC can be a safe choice for many women, there are risks to be aware of, including:
- Uterine rupture, although this is rare (usually occurring in 0.22-0.74% of cases).
- Failed VBAC, which may lead to an emergency Caesarean and the increased morbidity that comes from an emergency caesarean when compared with an elective repeat caesarean.
- Increased risk of stillbirth after 39 weeks, HIE or intrapartum death (related to scar rupture in labour).
- Pelvic floor trauma.
It's essential to discuss these risks with your healthcare provider to make an informed decision.
What can I do to prepare for a VBAC?
To increase your chances of a successful VBAC, consider the following:
- One of the most important aspects of considering a VBAC is having a supportive healthcare team. Ask your healthcare provider to provide you with statistics on how many VBACs they are successful with each year. It is also important to discuss with your healthcare provider their stance on inducing VBACS if labour doesn’t start spontaneously. This will help you to decide if your healthcare provider is supportive of VBAC.
- It is important to discuss your wishes for a VBAC with your healthcare team early in your pregnancy so that everyone can be on the same page.
- Try to maintain a healthy diet and exercise during your pregnancy
- Attend One Mama Midwife birth classes to learn about what to expect, what is normal and how to best cope through your labour and birth. This will also give you greater understanding of how to maximise your chances of a successful vaginal birth.
Can I still have pain relief during a VBAC?
Yes, you can still have pain relief during a VBAC, such as epidurals or intravenous medications. Your healthcare provider will discuss your pain management options with you, taking into consideration your medical history and the progress of labour.
What if I decide against VBAC?
The decision between VBAC and repeat Caesarean should be made based on your individual circumstances and preferences. There is no right or wrong option and you should make the decision that suits you and your family the best.
Conclusion
VBAC is a viable option for many women who have previously undergone a planned or emergency caesarean. However, it's crucial to consult with your healthcare provider to determine your eligibility and make an informed decision about your birth plan. Remember that the choice between VBAC and a repeat Caesarean ultimately depends on your unique situation and what you feel most comfortable with during this special time in your life.
___________________________________________________________
References:
Australian Institute of Health and Welfare (AIHW). Australia's Health 2018:in brief. Cat no AUS222.Canberra: AIWH. 2018.
Jozwiak M, Dodd JM. Methods of term labour induction for women with a previous caesarean section. The Cochrane database of systematic reviews. 2013;3:CD009792.
Ministry of Health. New Zealand Maternity Clinical Indicators 2015. Wellington: Ministry of Health. 2016. Available from: https://www.health.govt.nz/publication/new-zealand-maternity-clinical-indicators2015.
RANZCOG (2019) Birth after previous caesarean section - RANZCOG. Available at: https://ranzcog.edu.au/wp-content/uploads/2022/05/Birth-after-previous-caesarean-section.pdf (Accessed: 10 October 2023).