Is a Vaginal Birth After Caesarean (VBAC) right for you?

Are you pregnant for the second time? Congratulations! Did you have a caesarean section last time? Do you want to try a Vaginal Birth after Caesarean (VBAC) this time, or schedule another c-section or caesarean? When considering the birthing options for your current pregnancy, there are two primary choices to evaluate: a VBAC (Vaginal Birth After Cesarean) or scheduling another caesarean section.

According to distinguished healthcare practitioners of Aastrika Midwifery Centre, deciding whether or not to try for a VBAC requires reckoning with the details of a mother’s medical situation in the context of her values. 

Some women may want the experience of a vaginal birth because of its uncountable benefits but may need a caesarean because medical issues stand in the way. In contrast, others don’t mind another caesarean. Women sometimes get scared of labour pain in a normal birth as they have not experienced it earlier.

That’s okay! But once you have confirmed your pregnancy for the second time, you may wish to check whether a VBAC is a good option for you or not. Let’s find out.

Is a VBAC a good option for mothers?

Let us first define a normal vaginal birth. In layman’s terms, normal birthing refers to the process in which a baby is born through the birth canal (vagina) during childbirth. In a normal vaginal birth, the baby’s head typically emerges first, followed by the rest of the body. 

What is a VBAC? A VBAC means a successful Vaginal Birth After a Caesarean section. A VBAC is an excellent option for most to-be mothers as their chances of success are actually quite high. According to the National Institutes of Health 2010 consensus statement, women attempting a normal vaginal birth after C-Section have a 74% chance of vaginal birth.

Mothers who are eligible for a VBAC will be offered a medical option known as a TOLAC, or “trial of labour after caesarean”. A TOLAC may be presented for mothers who have undergone a C-section in a previous childbirth if their medical situation makes them eligible. A TOLAC involves attempting a vaginal birth in a subsequent pregnancy rather than opting for another caesarean section.

A TOLAC may end in a successful VBAC or a repeat caesarean. Planning a VBAC does not guarantee a successful VBAC, as a mother with a child trying for a VBAC with her second child might need a repeat caesarean if the doctors diagnose any issues.

On the other hand, a mother who has already had a caesarean with her first child may want to schedule a caesarean with her second one and end up in labour spontaneously.

It happens! That is why you first need to know whether you are the right candidate for VBAC. How will you find out? Let’s dig deep into it.

Are you the right candidate for a VBAC?

If you are considering a VBAC, you must discuss the below crucial questions with your doctor to help you choose the right course of action.

How many caesareans have you had before?

You might be a candidate for a VBAC even after having had one or two caesareans before. Additionally, if the caesarean scar on your uterus is low and horizontal, popularly known as a low transverse incision, you will be considered a good candidate for VBAC. 

According to the doctors, the incision placement on your uterus can usually be defined by the scar on your skin. For accuracy, they require your previous medical records.

Did you go into spontaneous labour in your previous pregnancy?

If you went into spontaneous labour in your previous pregnancy (and thus did not need an induction), the chances are higher that you will also go into spontaneous labour in your current pregnancy. This may make you a better candidate for a VBAC, as VBAC success rates are higher for women who go into spontaneous labour. 

What is the ideal wait time between pregnancies?

Ideally, a woman with a previous c-section may want to wait at least 18 months between pregnancies. If a woman becomes pregnant within 6 months or less after a caesarean, the doctor may not recommend a VBAC or a TOLAC because of the higher risk of complications, including the risk of uterine rupture.

What are non-repeating factors?

Non-repeating factors are circumstances that do not have a high chance of recurring. For example, twins, breech birth, placenta previa or placenta covering the cervix and placental abruption or placenta detaching from the uterine wall are non-repeating factors. You are a candidate for a VBAC even if you have already faced these circumstances because these are non-repeating factors.

Women whose first c-section was for a non-repeating factor are often good candidates for a VBAC or a TOLAC.

Sometimes your previous caesarean may have been for a repeating factor, that is, one with a chance of recurring. Examples include if your labour stalled, the baby didn’t come out even after pushing for a long time, or you stopped dilating.

Even in such a situation, you may be a candidate for a VBAC. These factors repeat depending on the details of your situation, and your healthcare provider will be the best person to decide if you can have a VBAC or a should plan for a repeat c-section.

Are you a breech candidate?

Keep in mind that if your baby is breech, you will not be an ideal candidate for VBAC unless your doctors successfully rotate the baby before labour.

VBAC (Vaginal Birth After Caesarean) for a breech baby (baby positioned buttocks or feet first) can carry some specific risks compared to a head-down baby.

1. Uterine Rupture: One of the main concerns with VBAC is uterine rupture, where the scar from a previous caesarean section tears or separates during labour. This can lead to severe bleeding and put both the mother and baby at risk.
2. Breech Birth Complications: Giving birth to a breech baby vaginally can increase the risk of complications such as head entrapment, cord prolapse (when the umbilical cord slips through the cervix before the baby), and birth injuries.
3. Scar Integrity: The strength and integrity of the previous caesarean scar are crucial factors. If the scar is thin, weak, or improperly healed, the risk of uterine rupture may be higher.

The likelihood of a successful VBAC with a breech baby varies depending on individual circumstances and medical history. Generally, VBAC success rates for breech babies tend to be lower than for head-down babies. 

Conclusion

VBAC services are provided by very few hospitals and birth facilities in India. This facility is typically offered if anesthesiologists and obstetricians are also ready for an emergency caesarean anytime. Skilled obstetricians and trained midwives can offer a VBAC in an appropriate birth setting, like Aastrika Midwifery Centre at Vasavi Hospital. With an interdisciplinary team of experienced doctors, midwives, and nurses, mothers receive the best care and experience a transformative and joyful birthing here. Call us to book an appointment for a VBAC.