Many women approaching a birth after a prior cesarean section delivery often wonder if a vaginal delivery is an option.
According to the American Pregnancy Association, 90 percent of women who have had cesarean deliveries are candidates for a vaginal birth. The Mayo Clinic estimates that 75 percent of women who try a vaginal birth after a C-section (VBAC) have a successful vaginal birth.
Concerns about VBAC
The main concern with VBAC is uterine rupture, particularly in women who attempt a vaginal delivery after being induced. Uterine rupture after induction has been documented to happen in women with both the low transverse incision or a classical incision performed for their C-section.
“If you had a previous cesarean with a low transverse incision, the risk of uterine rupture in a vaginal delivery is .2 to 1.5% ... approximately 1 chance in 500,” according to the American College of Obstetricians and Gynecologists. (2)
The classical incision, a north-south incision along the midline, is rarely used anymore, except in emergencies. A lower uterine transverse incision, typically referred to as a “bikini cut” because it runs just below the bikini line and just above the pubic hair, is the most commonly used C-section method nowadays.
Indications and Contraindications for VBAC
You may be a candidate for VBAC if:
• You only have one prior low transverse uterine scar and no other scars
• You and baby are healthy and pregnancy is progressing normally
• The reason for the previous C-section is not a factor in this pregnancy
• Labor begins naturally on or before your due date
• A previous vaginal delivery was successful
VBAC may not be possible if:
• You experienced previous uterine rupture during a pregnancy or delivery
• Your pregnancies tend to run overdue
• Your baby is unusually large
• You have had two or more prior cesarean sections and no vaginal deliveries
• You are obese
• You are expecting multiples
Reasons for Repeat Cesarean
A repeat cesarean may be necessary if:
• Labor has been long and difficult with slow cervical dilation, you have a small pelvis or a big baby. (2) If you’re using a midwife, doula or labor coach, it is important that she knows when to make that recommendation to you.
• You have a history of genital herpes. It is possible to pass this virus on to the baby during a vaginal delivery.
• Your baby is showing signs of distress. Nearly 10 percent of all cesarean deliveries are due to fetal distress. (2)
You should discuss all possible options associated with both VBAC and repeat C-section deliveries before making your decision. Remember, that each pregnancy and labor is different and some things cannot be anticipated. Be prepared for the possibility that a planned VBAC may turn into a repeat cesarean.
Sources:
1) VBAC (vaginal birth after C-section). MayoClinic. Web. May 1, 2012.
http://www.mayoclinic.com/health/vbac/MY01143
2) VBAC: Vaginal Birth after Cesarean. American Pregnancy Association. Web. May 1, 2012.
http://www.americanpregnancy.org/labornbirth/vbac.html
3) Caesarean section. Wikipedia. Web. May 1, 2012.
http://en.wikipedia.org/wiki/Caesarean_section
Reviewed November 8, 2012
by Michele Blacksberg RN
Edited by Jody Smith