Vaginal Birth After Cesarean Delivery (VBAC)

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Choosing a vaginal delivery after a C-section can be a safe and appropriate choice for many women. Studies have shown up to a 60-80% success rate for women who attempt VBAC. However, it is a very personal decision, as neither VBAC or repeat C-section are 100% free of risk or complications. It is very important for all patients considering a VBAC to carefully weigh the risks and benefits.

VBAC is recommended by the American College of Obstetricians and Gynecologists. More information can be found here: http://www.acog.org/Patients/FAQs/Vaginal-Birth-After-Cesarean-Delivery-Deciding-on-a-Trial-of-Labor-After-Cesarean-Delivery.

Who is a good candidate to attempt a VBAC?

A patient who has had 1 prior vaginal delivery with a normal incision on the uterus (side to side, or “low transverse”) is a good candidate for VBAC. Your prior hospital records will be used to confirm the location of the uterine incision, as your scar on your abdomen frequently may not be the same as the scar on the uterus.

Who is not a good candidate for VBAC?

Any of these complications may increase the risk of uterine rupture:

  • History of multiple C-sections
  • Vertical or “classical” incision on the uterus
  • Medical complications including but not limited to diabetes, hypertension, preeclampsia

What are the benefits of VBAC?

Your future plans for more children may impact your decision. Because C-sections become more risky with each subsequent surgery, you may want to consider VBAC if you plan to have a large family. Other benefits include:

  • Avoiding major surgery
  • Decreased recuperation time and hospital stay
  • Decreased risk of blood loss or infection

What are the risks of VBAC?

The main risk of VBAC is a small risk of uterine rupture or a tear in the wall of the uterus. This happens in less than 1% of appropriately selected patients. If uterine rupture were to occur there is an increased risk of:

  • Emergency C-section
  • Blood transfusion
  • Hysterectomy
  • Fetal injury or stillbirth

What are the risks of repeat C-section?

  • Increased risk of blood loss, infection, injury to adjacent organs
  • Abnormal implantation of the placenta requiring preterm birth, blood transfusion, or hysterectomy
  • Increased recuperation time and hospital stay

You can use the Maternal-Fetal Medicine Unit Network Calculator to see your own calculated success rate based on age, BMI, and other prior history: https://mfmunetwork.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html. Evidence suggests that women with at least a 60–70% chance of successful VBAC have less risks for VBAC vs. C-section. However if your chance of success is less than 60%, the risks of VBAC may outweigh the benefits.

What increases my success rate?

  • Prior vaginal delivery or VBAC
  • Spontaneous labor
  • Age less than 35
  • Prior C-section for breech position or fetal distress

What decreases my success rate?

  • Need for induction
  • Delivery after 40 weeks gestation
  • Age over 35
  • Obesity
  • Prior C-section for failed induction
  • History of large baby or current large baby
  • Patients who delivered prior baby less than 1 year ago

Please discuss VBAC with your doctor during your visit. Your doctor will help you evaluate your personal risk and chance of success and guide you though the process. If you and your doctor decide to attempt a VBAC, it is important for all patients to realize that your health and your baby’s health is the most important priority to all the physicians at Advanced Ob-Gyn Associates. While we want to provide every patient with their desired birth experience, all patients must be prepared to make changes as necessary to keep them safe. 

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