To VBAC or Not

**Disclaimer: Material on this blog is intended for informational purposes only. This blog does not give medical advice and none of the content, including my opinion and any linked materials should not be substituted for your own doctor’s care or advice. If the reader has a medical concern, he or she should seek help from an appropriately licensed medical professional and never disregard professional advice or delay seeking professional advice due to the opinions and other content within this blog.

 

 

I remember when I was pregnant with Braydon, I was talking to a friend about giving birth and I mentioned I am trying for a VBAC. She looked at me puzzled asking what it was and said, “I thought since you had a csection with Shayne, you had to have a csection for any other babies you have?!” Unfortunately, this has become the belief of many people and even many OBs. In fact, 92% of woman who had a cesarean go on to have an elective repeat cesarean. What is so unfortunate about this you ask? Well for most woman who have had a previous cesarean, it is the safer option for her to have a VBAC or vaginal birth after cesarean. In this post I will outline the risks and benefits of choosing a VBAC, the risks of multiple repeat cesareans, who are good candidates for vbac and why I chose to have one.

The Risks of VBAC

In my opinion, the only risk when it comes to having a VBAC is the chance of uterine rupture. I am not going to lie, it is a big deal when it happens, and it does happen. A uterine rupture is when a weak spot or prior cesarean scar in the wall of the uterus tears. It is a potentially catastrophic event that can lead to the death of the baby, mother or both. However, the chances of uterine rupture happening is rare, below 1%, between 0.4-0.8% depending on factors. Some of these factors include whether or not the woman went into labor on her own vs. being medically induced, if the patient has one or two prior cesareans, the type of cesarean cut and whether or not labor was augmented at all. In a low risk patient with one low transverse cesarean cut who goes into labor on her own, the risk of true uterine rupture is 0.4%. It is important to note that it has been found that of all uterine ruptures (varying cesarean cuts, spontaneous or augmented labor) 0.7% are true uterine ruptures and 0.7% of all uterine ruptures resulted in uterine dehiscence or incomplete uterine rupture. Uterine dehiscence often shows no signs of occurring, does not pose any threat to mother or baby and does not need any treatment or repairing. It is important to also know the chances of uterine rupture are similar to other emergencies in labor such as shoulder dystocia, cord prolapse and placental abruption which can happen in any labor regardless of prior cesarean or not.

The Risks of Elective Repeat Cesareans

  • Risks associated with cesarean surgery such as placenta accreta, blood transfusion and hysterectomy increase with each surgery
  • Higher chance of infection and blood loss
  • Increased chance of neonatal breathing difficulties
  • Longer hospital stay
  • Increased chance of blood clots
  • Possible complications from spinal tap or epidural

The Benefits of VBAC

  • 75% of attempted VBACs are successful
  • No major abdominal surgery needed
  • Shorter recovery time
  • Lower risk of infection, blood loss and other complications associated with surgery
  • Fewer neonatal complications
  • Risk of uterine rupture decreases with each successful VBAC

Who Makes a Good Candidate for VBAC?

According to ACOG (American Congress of Obstetricians and Gynocologists), “VBAC is a safe and appropriate choice for most woman with one prior cesarean and some woman who have had two prior cesareans.” It is preferred that any previous cesarean incisions be low transverse or “bikini cut”. As far as other criteria that would make a woman an “ideal” candidate for VBAC, it really depends on each individual situation. If you are considered high risk due to other medical conditions, you may not be a candidate for VBAC. Many OBs will want their VBAC patients to have no more than one or two prior cesareans, be within their normal BMI (body mass index) range, have 18 months or more between pregnancies and have no other complications such as gestational diabetes or high blood pressure. This doesn’t mean you can’t have a VBAC if you don’t completely match this criteria. Like I said, it is important to go in depth with your provider in order to determine if you are a good candidate or not.

Why I Chose to Have a VBAC

For me, it was a no brainer. Considering that the risk of uterine rupture is so low and my past pregnancy, labor and delivery history, I knew I had the best chance of having a successful VBAC. I did not fit into the mold of what most doctors would consider the ideal candidate considering I was very much overweight when I got pregnant with my second child and with my family history of diabetes. But I also knew I had at least a 75% chance of being successful. I knew as long as I found a supportive provider and did my research, I could do it. And I did! As for my personal experience as far as recovery and the differences in how I felt after both my births, it was night and day! With my csection, I was in the worse pain I have ever experienced the morning after. I was forced to get out of bed and walk. I couldn’t sit up on my own or stand without help. Everyday, it got easier but even after being in the hospital for almost 4 days, I was still in bad pain when I went home. I am lucky I had my husband home to help me out as getting in and out of bed was difficult and painful for almost a week and a half after my csection. I was prescribed pain medicine that I took 1-2 times a day and I needed it for almost 2 weeks postpartum. I knew I did not want to experience this again if I could help it. With my VBAC, since I went all natural without any drugs of any kind, I was up walking on my own and going to the bathroom within 2 hours of my son being born. I had very little to no pain, in fact I was the one who pushed his bassinet from my labor and delivery room to my postpartum room. I took advil for pain as needed while in the hospital and was discharged and home just over 24 hours after he was born. I did have a prescription for pain meds but chose not to get it filled because I had no use for pain medicine. Of course, every woman’s experience will be different, but this was mine and I would choose a VBAC over RCS (repeat cesarean section) any day.

I hope this post will help those of you who have had a prior cesarean realize that it is possible and in most cases, safer to have a vaginal birth after cesarean. The “once a csection, always a csection” mentality needs to become a thing of the past. So many woman are not even given the option of VBAC and some woman who ask about VBAC are scared into believing it is dangerous. I am not saying that all woman with prior cesareans can or will go on to have a VBAC. This is not meant to bash woman who had cesarean births due to medical necessity or emergency. It is meant to help bring to light that VBACs are not scary or dangerous and for those who make good candidates, they are much safer for both mother and baby. Know you have options and rights!

 

References and further reading:

 

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8 thoughts on “To VBAC or Not

  1. Very good information, and it’s great you were able to have a VBAC!
    I would like to know more about repeat cesareans…is there a limit to the number of abdominal surgeries a woman can have? I mean, say my first baby was delivered via C-section but I had a VBAC for all babies after that – wouldn’t that mean I could have more children than if I chose to have repeat C-sections over and over?

    • Great question! Not many mothers worry about since a cesarean section is a “routine” surgery, and are led to believe it doesn’t come with any risks. What many people need to realize is it is indeed major abdominal surgery! I touched base a bit on this in the section about risks of repeat cesareans. I have never heard of a dr limiting the number of cesareans a mother may have. However, I do know that after 3, many doctors will weigh out the options with the mother as it will depend on each individual. I actually asked my first OB after the birth of my first son, who was born via cesarean. She told me that she had clients who had 3 or 4 cesareans and were all “fine”. However, the risks significantly increase with each cesarean. I love the graphic/ chart in this link: http://www.ican-online.org/vbac/home . It shows the increase in each of the percents of the risks of hysterectomy, blood transfusion, placenta accreta, adhesions and other major complications that come with having cesarean. And all of these risks have a greater chance of happening than uterine rupture during a VBAC. I personally, would say yes, if you have one cesarean then have all other births after that be VBACs, you have better chance of having more children. However, I am sure there are women out there who have had 3, 4 or more cesareans without major complications. But I would like to bet that many of those mamas ended up with a hysterectomy at the advice of their doctor where as a mama with multiple VBACs has not. Unfortunately, I have not found any significant research on setting limits of repeat csections. This is something I hope someone will look at one day in order to help more women achieve VBACs.

      • Thank you so much!
        I wonder how much information is given to a woman in regards to repeat cesareans/VBACs…risks, benefits, etc. This seems like a very important thing to discuss with a doctor and also research yourself.

      • You are welcome. The thing is, not many woman are educated on this. MANY doctors these days are all about once a csection, always a csection and refuse to do VBACs. They say how dangerous VBACs are when the numbers prove otherwise. Many hospitals also have VBAC bans. It is quite sad that so many mom fall victim and don’t get the birth they may want and deserve to have. This is a big reason why I started my blog. I know firsthand what it is like to fight to get the birth I wanted and knew was safer for myself and my baby (and future babies). I hope I can eventually reach many moms in the same position and just get them to research, ask questions and do better for themselves and their babies.

      • Yeah, I’ve talked to a number of women who have said they weren’t “allowed” to try for a VBAC at their hospital. :/ That being said, they weren’t unhappy with their births, but still…they would have wanted the option.

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