VBAC Resources
“Once a Cesarean birth, always a Cesarean birth.” Is what doctors used to tell birthing people who had a previous cesarean birth, but that’s not true for everyone!! The American College of Obstetricians and Gynecologist (ACOG) has recommended VBAC as a safe and appropriate choice for most birthing people who have had a prior cesarean birth.
Vaginal birth after cesarean (VBAC) refers to a vaginal birth after having a previous cesarean, is not inherently “high tech”, but is treated as inherently high risk in many hospitals and by many obstetricians.
The act of trying and working towards VBAC is called TOLAC (trail of labor after cesarean). The most influential factor of success of a VBAC attempt is the choice of your care provider. It’s important to know your provider's policies or deadlines on when you must spontaneously begin labor, their policies on use of augmentation or induction, their time limits and personal threshold for risk do in fact influence the odds of you successfully achieving a VBAC.
What are the risks of a VBAC? Some risks of a VBAC are infection, blood loss, and other complications. The main risk cited for VBACs are uterine ruptures. This is a tear in the wall of the uterus, and it often occurs at the site of a previous cesarean incision. While uterine rupture is a potentially dangerous complication, it's rare. There’s a one-in-200 chance of uterine rupture, and if that happens, there’s a three-in-10,000 chance of fetal loss. You might have also heard of uterine dehiscence. What is the difference between uterine rupture and dehiscence? Uterine rupture was defined as a clinically apparent, complete scar separation in labor or before labor. Uterine dehiscence was defined as an incomplete and clinically occult uterine scar separation with intact serosa. Uterine dehiscence can be encountered at the time of cesarean delivery, be suspected on obstetric ultrasound, or be diagnosed in between pregnancies. Management is a conundrum for obstetricians, regardless of timing of onset.
3 VBAC myths:
Myth: I can’t have a VBAC in my state because it’s illegal.
VBAC is legal throughout the United States and in some states, it’s legal for a midwife to attend a community VBAC where birth occurs at home or at a birth center.
Myth: There is a 25% chance that someone will die during a VBAC.
The risk of maternal mortality is very low whether a birthing person plans a VBAC (0.0038%) or an elective repeat cesarean (0.0134%).
Limited evidence suggests that there is a 2.8%–6.2% risk of perinatal death (the baby died either during labor or within 28 days of being born) after a uterine rupture with many factors contributing to this range.
Myth: There are no risks associated with cesareans other than surgery.
The most serious cesarean-related complications become more likely as an individual woman has more cesareans.
Placenta accreta, when the placenta embeds too deep within the uterus, is one such condition. It carries its own risks including excessive bleeding, blood transfusion, hysterectomy, surgical injury, and maternal death.
After two cesareans, the risk of accreta is 0.57%, slightly higher than the risk of uterine rupture after one cesarean.
The American Pregnancy Association estimates that 60%-80% of people who attempt a vaginal birth after Cesarean will be successful. Those are some encouraging percentages! Although the rate of success is high there are things to consider avoiding during a VBAC. Avoid medical induction. When at the end of your pregnancy, try your best to go into labor naturally. Medical inductions can increase your likelihood of a failed attempt at a VBAC, as they can put too much strain on your uterus. Don't expect to control the outcome of your birth, be prepared for any outcome. Know that even with all your preparation, you cannot control the outcome of your birth. If you must have a repeat cesarean, know that you were informed and prepared to the best of your ability. Try not to view this as a failure. Give yourself grace and understanding. Don't skip out on self care! Take care of yourself, treat your body with great tenderness throughout your first year after surgery. Use skin-safe oils to massage your scar and reduce scar tissue. Take vitamins and herbs that are shown to strengthen your uterus, such as evening primrose oil and red raspberry leaf. Drink plenty of water and exercise regularly to gain mental and physical stamina. Get outdoors often. Avoid skipping out on your homework! Read as much as you can about VBACs. There are many books out there, so I would suggest looking for recent publication dates and scientific data (as opposed to anecdotal stories). To get started, take a look at Birthing From Within by Pam England CNM, MA and Birthing Normally After A Cesarean Or Two by Helene Vadeboncoeur. Find studies about VBAC research and educate yourself on what your care provider should be aware of.
Generally, VBAC is recommended as a safe option for birth people. Like anything in pregnancy and birth, there is a risk benefit analysis that needs to be done based on your values and specific situations. Dig deep, choose what best aligns with you when making decisions regarding VBAC. Education is power, and the best way to prevent unnecessary interventions like cesarean; understanding when and why is crucial. Hiring a doula to support you in your journey to a VBAC is highly suggested. A doula can help you navigate the medical system and give you the valuable tools you need to prepare your body, mind, and heart for a VBAC. Know that you can do this! This is your birth and you have the right and responsibility to want the best for yourself and your baby.
Good luck!