What is a VBAC?
Lots of women go on to have a vaginal birth after having a caesarean. Here’s some information to help you make that decision between a VBAC and another c-section.
What is a VBAC?
VBAC is a vaginal birth after a caesarean. It means having your baby vaginally when you've had at least one baby by caesarean section, also called a c-section.
How does a VBAC differ from other vaginal births?
Most women are able to have a VBAC without any complications. But there is a small risk that the scar from your previous c-section could tear. This is called uterine rupture.
It may be reassuring to know that uterine rupture affects just one in 200 women trying for a VBAC. However, your medical team will watch out for it, as it’s a serious complication that can put you and your baby at risk. If you go into labour prematurely (before 37 weeks), VBAC is still an option.
You’ll find that your labour will be checked more closely and more often if you’re aiming for a VBAC. During your labour you'll be offered continuous electronic fetal monitoring.
This will measure your baby's heart rate and your contractions, but you this will confine you to the bed and restrict movement. You can ask to be monitored with a hand held monitor and frequently so you can have free use of the space and be able to use all the different birthing positions you have learnt through LushTums.
If your baby's heart rate doesn't sound right, it could be an early sign that there’s a problem with your scar. The team looking after you can then act quickly to keep you and your baby safe.
Because of the risks surrounding VBAC, your doctor is likely to recommend that you give birth at a unit that has an operating theatre and an on-site blood transfusion service. This may sound alarming, but it’s just a precaution to make sure you and your baby are in safe hands.
What pain relief can I have during a VBAC?
You will be able to have the same pain relief options during your VBAC, as you would have for a first-time vaginal birth, including an epidural. However, an epidural may mean that you’re not as aware of the early symptoms of uterine rupture. These include severe abdominal pain that lasts between contractions and sudden tenderness of your scar.
Depending on your pregnancy history and your hospital, you may be able to use a birth pool to help you to cope with your contractions. Using a pool may mean it's not possible to monitor your baby all the time. Some units have special continuous monitoring systems (telemetry), which have waterproof pads that attach to your tummy and work wirelessly.
Pain Relief Ladder
Before going straight for the medical relief try some of these alternatives first. You will be surprised just how well they go with all of the positive Birthing Mindset tools and techniques you have to birth you baby with ease and love.
• Yoga Birthing Poses
• Birthing Breath
• Massage
• Heat
• TENS Machine
• Reflexology
• Aromatherapy
• Acupuncture
• Bachs Flower Remedies
• Bath/Birth Pool
• Homeopathic Remedies
Medical Pain Relief
Entonox (gas & air) works quickly and wears off. May cause nausea.
Pethidine - This is an opiate given as in injection in the thigh. It is very effective in relaxing stressed women who have had a long latent phase of labour but, it can cause nausea and vomiting.
Epidural - a local anaesthetic is injected into the epidural space between the second and third lumbar vertebrae. The drug action the spinal nerves to produce a sensory and partial block. It is pain free, women can sleep and good for long labours and complicated deliveries. Mobility, however is restricted and the risk of having further medical intervention and assisted with rises.
Remember: “Everything has a place!”
What’s the alternative to a VBAC?
If you’re not sure about going for a VBAC, you could have a planned repeat caesarean. This is usually booked for the seven days leading up to your due date, unless your doctor thinks its better for your baby to be born sooner.
In some circumstances, your doctor may recommend a caesarean as the only safe option for you or your baby, because of your medical history. This includes:
• uterine rupture in a previous pregnancy
• a vertical, rather than a horizontal c-section scar
• a previous labour complication, such as placenta praevia
Your doctor may also recommend a caesarean if you’ve previously had an operation for fibroids or another uterine abnormality that has left scarring.
If VBAC or caesarean are both options for you, you'll have plenty of time to consider the risks and benefits of each, so talk to your obstetrician about your previous births. You'll be encouraged to decide by the time you're 36 weeks pregnant.
What are the advantages of a VBAC?
A successful VBAC carries the lowest risk of complications. If you have a VBAC, you’ll avoid the risks associated with repeat caesareans and have a quicker recovery time.
Looking after a toddler and a new baby without the discomfort of a c-section wound will also be easier.
With a successful VBAC, you'll have a shorter stay in hospital and you should experience less pain and discomfort in the weeks and months after the birth.
If you‘re planning more pregnancies, then trying for a VBAC may help you to avoid future complications that are more likely after repeat caesareans, including placenta praevia, placenta accreta and hysterectomy.
Once you've had one successful VBAC, you're more likely to have another one in the future.
What are the disadvantages of a VBAC?
The disadvantages of a VBAC are similar to those of a straightforward vaginal birth. In the short-term, these can include:
• Pain from bruising and stitches in the area between your vagina and back passage (perineum).
• Leaking wee while the area around your vagina recovers.
Pregnancy itself can weaken your pelvic floor, so having a c-section doesn’t necessarily protect you from pelvic floor problems in later life. It's important to do your pelvic floor exercises, whichever way you give birth. To find your nearest LushTums Postnatal Yoga Classes go to www.lushtums.co.uk
Giving birth vaginally, whether it’s your first time or you’re trying for a VBAC, may slightly increase the risk of your womb slipping into your vagina (prolapse). But there are other factors that may contribute to prolapse in later years, such as:
• age, as the older you get the more likely it is to happen
• the number of babies you've had
• whether your mum or sister had a prolapse
• whether you’re very overweight
• whether forceps or ventouse were used during your vaginal birth or births
• whether you had a big baby
• whether you’re often constipated
Trying for a VBAC after one previous caesarean, instead of choosing a repeat caesarean, carries a slightly higher risk of some more serious complications, such as:
• a blood transfusion
• infection in your uterus
• uterine rupture
However, these serious complications are not common, and the risk of them happening to you is very small.
What other risks do I need to be aware of?
Every labour is different, so there's always a chance that you may need help to give birth. One quarter of women who try for a VBAC need an emergency c-section. This usually happens because labour has slowed right down, or there are worries about the baby's wellbeing.
The risk of complications is generally higher with an emergency c-section than with a planned c-section. But bear in mind that if you’re trying for a VBAC, you’re about as likely to need an emergency c-section as if you were a first-time mum aiming for a vaginal birth.
The risk of serious complications for your baby is also very low and similar to a woman trying for a vaginal birth with her first baby.
How do I decide whether to aim for a VBAC?
Take time to explore your feelings about the birth. Talking it over with your midwife and doctor, and your loved ones, may help. You may find the prospect of an emergency c-section instead of a successful VBAC too upsetting. Or you may feel that its better to at least try for a VBAC and see what happens. Trust yourself and your instincts; you know what is right for you and your baby.
Some maternity units run VBAC clinics, so you can talk to a consultant and midwife about how you might be monitored, as well as your pain relief options. Attending our LushTums antenatal classes will help you reach a decision that you are happy with.
What are my chances of a successful VBAC?
Your chances of having your baby vaginally are likely to be good, though it depends on:
• why you needed a c-section previously
• whether you've ever had a baby vaginally
• whether you’ve had any other complications during this pregnancy
If you needed a caesarean to give birth previously because of a uterine abnormality, then you may need to have a repeat caesarean. However, if you had a c-section because of something unique to your last pregnancy, such as a breech baby or a low-lying placenta, you stand a good chance of having a successful VBAC.
You may find it useful to see what your chances are of a successful VBAC:
• Between 85 per cent and 90 per cent if you've had one or more babies vaginally in the past, particularly if it was a VBAC.
• Between 72 per cent and 75 per cent if you've had one previous c-section.
• About 71 per cent if you've had two previous c-sections.
If your labour starts prematurely, your chances of a successful VBAC are similar, although you have a lower risk of uterine rupture.
VBAC success rates are lower if you:
• Have your labour induced or speeded up, as it puts a strain on your scar.
• Have only ever given birth by c-section.
• Previously had a c-section because your labour was slow or because your baby couldn’t be born vaginally.
• Have a body mass index (BMI) of over 30 at the start of your pregnancy, as this can affect how you labour.
If all four of these factors apply to you, your chance of having a successful VBAC is reduced to 40 per cent. There are some circumstances in which a repeat caesarean may be safer than a VBAC, including if:
• You gave birth less than 12 months ago
• You’re more than 41 weeks pregnant.
• You’re aged 40 years or older.
• You’re expecting a big baby. Though accurately predicting a baby's birth weight in late pregnancy isn't easy.
• An ultrasound scan or MRI reveals that the lower segment of your womb looks thin.
If any of these apply to you, it’s likely that you’ll get advice from a senior obstetrician to help you reach a decision that’s right for you.
Can I have a VBAC at home?
A home birth is an option if you're having a VBAC, your doctor and midwife will probably advise you to have your baby in hospital but you can decide to have your baby at home.
They will recommend that you have continuous electronic fetal monitoring (EFM) during your labour, but remember they do have hand held monitors and can monitor you more frequently so you can have freedom of movement.
Having a VBAC in hospital means that if your scar tears you can be treated straight away with a c-section that should be done as soon as possible. If you’re planning to try for a VBAC at home, it may help to find out what the transfer time to hospital would be.
If your heart is set on a home birth, it's worth contacting a local supervisor of midwives or midwifery advocate by phoning your maternity unit. A senior midwife can take you through all your options and help you to plan the safest care for you and your baby.
Another option is to employ an independent midwife, a Doula, you can use the Independent Midwives Association’s Find a Midwife service for a list of midwives in your area. And for Doula’s we highly recommend using Conscious Birthing, you can find their directory here:
http://www.consciousbirthing.co.uk/find-a-doula
You can find more information on trying for a vaginal birth after caesarean by calling the VBAC Information and Support helpline on 01243 868440 (open 9am-9pm).