Sunita was excited to learn she was expecting again. She and her husband had a three year old little boy and they felt that their family wasn't complete yet. Her excitement was tempered by one concern, though. Several hours into labor with their son, he had started to show signs of fetal distress. Her doctor made the decision to do an emergency C-section and almost before she'd known what was going on she'd been wheeled into an operating room. Now, years later, Sunita wondered whether there was any chance she'd be able to have a vaginal delivery this time or if the only option was a repeat C-section.
Sometimes pregnancy can feel like a dizzying whirl of decision-making. Will you breastfeed or use formula? Should you do genetic screening? What about circumcision? Things get even more complicated if you've previously given birth via C-section and are expecting again. Suddenly, there's an additional important decision to consider: attempt a VBAC or not?
VBAC, or Vaginal Birth After Cesarean, is when you have a normal delivery after having a previous C-section. While a number of factors affect whether you're a good candidate for VBAC, in many cases it is a safe alternative to having a planned C-section and one that should be given serious consideration.
For many people, C-sections have come to be viewed as virtually routine, despite the fact that they remain invasive and expensive surgeries. While no one can debate the fact that C-sections can be critical, life-saving procedures, the rise in Cesareans in India over the last few decades raises concerns. Until 2010, C-sections represented only about 8.5% of births in India. Since then, the rates have skyrocketed, averaging around 50% for some areas of the country
This is an unfortunate trend, considering the possible advantages of VBAC compared to a C-section. First, VBAC, like all vaginal deliveries, involves a shorter hospital stay, a shorter recovery, and less pain after delivery. Babies born naturally are also less likely to experience neonatal breathing problems because vaginal birth forces fluid out of the baby's lungs. There may be emotional benefits as well as you and your partner will be more likely to play an active role in the delivery experience than you would during a C-section.
The choice of VBAC versus C-section becomes especially important if you are considering becoming pregnant again in the future. Each time a C-section is performed, it causes scarring to the uterus. As the amount of scarring increases, there is a greater likelihood of problems in subsequent pregnancies, especially with the placenta. Conditions such as placenta previa, placenta accreta, and placenta abruption all become more common with multiple C-sections. Bowel and bladder injuries are also more likely to occur with repeat C-sections. For these reasons, conventional wisdom suggests limiting the total number of C-sections a woman experiences.
Of course, there are also risks associated with having a VBAC. Most serious among these is the possibility of the uterus tearing at the site of a previous C-section incision. Known as uterine rupture, this rare condition can have dire consequences for both mother and baby, especially if the tear goes through all layers of the uterus. Fortunately, uterine rupture is rare, and may happen in only 0.5 percent of VBAC labors; and of the cases where ruptures do occur, less than 5 percent result in serious outcomes for the mother or baby.
Besides uterine rupture, there is also the possibility that a VBAC attempt will result in an emergency C-section. Typically, a VBAC begins with a trial of labor where the mother is either allowed to begin labor naturally, or is induced to start contractions. The labor proceeds similarly to a typical vaginal delivery, although during a VBAC the doctor monitors both mother and baby closely in case an emergency C-section becomes necessary. While the majority of women who begin a trial of labor will complete a successful VBAC, roughly 20-30 percent will ultimately require a C-section to deliver.
If you are considering a VBAC, it's important to identify an obstetrician with specific experience performing these kinds of deliveries. She will be able to discuss what factors may affect your likelihood of having a successful VBAC, such as the reason for your previous C-section, the type of incision made during your C-section, whether you've previously had a successful vaginal delivery, the time since your last C-section, etc. She should encourage you to ask questions and fully explore all of your options. While not every woman is a good candidate for a VBAC, for most it is a safe option that the right doctor will feel comfortable discussing.
An experienced doctor will also be able to help you select the best place to deliver when considering a VBAC. Each hospital and birthing center is likely to have unique guidelines regarding VBAC attempts, so it's important to find out ahead of time what policies affect your choice to give birth at a specific location. It's also a good idea to confirm the location's ability to provide rapid access to surgery and anesthesia in case an emergency C-section becomes necessary. Locally, the Birthplace is proud to support mothers who choose to attempt vaginal births after having C-sections and has several successful stories to it’s credit.
For Sunita, like most women, a VBAC ended up being a safe alternative to having a C-section. If you've had a previous Cesarean delivery, taking time early on in your pregnancy to discuss with your gynecologist whether a VBAC is right for you, will help put your mind at ease and leave you more time to wrestle with other important pregnancy decisions...like nursery colors and baby names!
Best Wishes from the Birthplace !
