Vaginal Birth after Cesarean (VBAC)

Vaginal Birth after Cesarean (VBAC)

A cesarean birth is the delivery of a baby through an incision (cut) made in the mother's abdomen and uterus. Doctors used to believe that if a women had one cesarean delivery, that all her other children would be born in the same way. Today, doctors know that many women who have had a cesarean delivery can later safely give birth through the vagina. This is called vaginal birth after cesarean delivery or referred to as a "VBAC."

Of women who try VBAC, 60-80% succeed and are able to give birth vaginally. The success rate varies depending on the reason for the previous cesarean, for example if the Cesarean was performed for breech delivery there is a 90-95% chance of success.

The advantage to VBAC are: no abdominal surgery, shorter hospital stay, lower risk of infection, less blood loss and less need for blood transfusions.

There are risks with VBAC. The risk of uterine rupture or that the cesarean scar may tear during the labor or the birth are two of these risks. Uterine rupture rate is approximately 1%. Uterine rupture is a serious life threatening occurrence for both Mom and baby.

If you have had a previous Cesarean it is important to locate your operative note from that delivery to assure you are a candidate for a VBAC. Only women that have had a low transverse cesarean section are candidates for a VBAC. Vertical incisions on the uterus or "classical" incision should not attempt a VBAC. With proper counseling and support VBAC can be a reality for most women.

UH St. John Medical Center guidelines for women with a single prior cesarean section include:

  • Only women who meet the following criteria will be offered a trial of labor:
    • Patient has no more than one previous cesarean delivery
    • Operative report from previous cesarean delivery reviewed
    • Previous Cesarean delivery documented as low transverse Cesarean Delivery. No history of a classical or low vertical Cesarean Delivery
    • No history of uterine incision with entry into the endometrial cavity for gynecological surgery
    • Maternal Body Mass Index at first prenatal visit is less than or equal to 35
    • More than 18 months or greater have elapsed from previous cesarean delivery and the estimated due date for current pregnancy
  • Continuous electronic fetal monitoring is required during labor.
  • An intravenous line (IV) is placed in labor for access in the event of an emergency.
  • Repeat cesareans are not scheduled until after 39 completed weeks gestation to ensure the baby’s lungs are mature.  If labor starts before 39 weeks, a cesarean can be performed at that time if desired.
  • Estimated fetal weight must be less than 4000 grams to proceed with trial of labor
  • Induction of labor will not be done for women with a previous cesarean delivery
  • If labor does not start by 41-42 weeks, women wishing a VBAC should be re-assessed and counseled by an obstetrician.

If interested further, please call or make an appointment with our office to review your obstetrical history.

 

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