Planned Vaginal Birth After C-Section
Childbirth is one of the most profound and rewarding experiences a person can go through. For some mothers who have previously undergone a caesarean section (C-section), the decision regarding their next delivery can be complex and deeply personal, often revolving around whether it is safe to attempt a vaginal birth after C-section (VBAC).
Dr Lanziz Homar is a highly experienced gynaecologist and obstetrician and enjoys a special interest in VBAC pregnancies. He offers personalised, respectful, and gentle care for his patients, prioritising their preferences and safety.
Why Consider VBAC?
Several factors can influence a woman’s decision to pursue a VBAC. Many women express a desire for vaginal birth, viewing it as a more natural and less invasive way to welcome their child into the world. Women also appeal to the shorter recovery period associated with VBAC, ensuring they can return to activities and caring for their newborn with fewer surgical complications. Having a VBAC can potentially reduce the risks associated with multiple C-sections in future pregnancies, such as uterine rupture and placental abnormalities, which may occur with each subsequent surgery.
Achieving a successful VBAC can be emotionally empowering for some women, especially if their previous birth experience was traumatic or eventful.
Factors Affecting VBAC & Eligibility Criteria
Sadly, not all women are considered suitable candidates for VBAC. Eligibility criteria may vary depending on several factors:
- Type of Uterine Incision: The type of uterine incision from the previous C-section plays a crucial role. A low-transverse incision (horizontal) is associated with a higher VBAC success rate compared to a vertical incision, which poses a greater risk of uterine rupture.
- Uterine Rupture: If there has been a previous uterine rupture, the risk of another rupture during a VBAC increases significantly. This is a critical consideration and often contraindicates attempting VBAC.
- Previous Uterine Surgeries: Any previous surgeries on the uterus may impact eligibility for VBAC. For instance, extensive uterine surgeries might weaken the uterus, increasing the risk of complications during a subsequent vaginal birth.
- Previous Vaginal Deliveries: Women who have had previous vaginal deliveries may have a higher chance of successful VBAC compared to those with no prior vaginal births.
- Number of Previous C-sections: The risk of complications, including uterine rupture, increases with each successive C-section. Women who have had one previous C-section generally have a higher likelihood of VBAC success compared to those with multiple prior surgeries.
- Reason for Previous C-section: If the previous C-section was due to a specific medical condition or complication that hasn’t resolved, it might impact the eligibility for VBAC. However, reasons such as foetal distress or failure to progress may not necessarily repeat in subsequent pregnancies, increasing the chances of VBAC success.
- Interval Between Pregnancies: A longer interval between pregnancies (typically 18-24 months of more) may improve the likelihood of VBAC success as it allows for adequate healing of the uterine scar tissue.
- Maternal Health Factors: Maternal age, body mass index (BMI), overall health, and presence of medical conditions such as diabetes or hypertension can influence VBAC outcomes.
- Labour Induction or Augmentation: The use of labour-inducing medications or techniques to speed up labour may increase the risk of uterine rupture and impact VBAC success rates.
Benefits & Potential Risks
As with any form of childbirth, there are benefits and risks to consider.
Benefits
For eligible candidates, VBAC offers several potential benefits:
- Lower Risk of Infection: VBAC is not a surgical procedure, reducing the risk of surgical site infections associated with C-sections.
- Shorter Hospital Stay: Generally, mothers who undergo a VBAC have shorter hospital stays compared to those who have a C-section, allowing them to recover in the comfort of their own home sooner.
- Promotion of Bonding and Breastfeeding: Vaginal birth may facilitate early bonding between mother and baby and promote successful breastfeeding, as the hormonal changes that occur during labour and delivery can support lactation.
Risks
While VBAC can be a safe option for many women, it is not without risks:
- Uterine Rupture: Although rare, this is the most serious risk associated with VBAC. Uterine rupture occurs when the scar from a previous C-section tears during labour, potentially leading to life-threatening complications for both mother and baby.
- Failed VBAC: In some cases, labour may not progress as planned, resulting in a failed VBAC and the need for an emergency C-section.
- Potential for Complications: As with any childbirth, there is always a risk of complications such as foetal distress, haemorrhage, or infection, regardless of whether it is a vaginal delivery or C-section.
How Patient Care Differs for VBAC
Women considering VBAC receive comprehensive counselling from their healthcare providers. This involves discussing the risks and benefits, reviewing medical history, and addressing concerns.
Healthcare providers collaborate with patients planning a VBAC to develop personalised birth plans, taking into account the patient’s preferences, previous birth experience, and medical history.
During labour, patients attempting VBAC are typically subject to continuous monitoring for signs of uterine rupture or other complications, and monitoring of the baby’s heartbeat to detect any changes that may result from your uterine scar. Your labour progress will be monitored continuously throughout, and you will be advised if a repeat C-section is required. VBAC often involves a collaborative, multidisciplinary approach, with obstetricians, midwives, nurses, and anaesthesiologists working together to support the mother and ensure a safe delivery.
If you’re considering a planned vaginal birth after a previous C-section, schedule a consultation with Dr Lanziz Homar. He is known for providing his patients with personalised and respectful holistic care and has a special interest in VBAC delivery.