When a mom previously has a cesarean delivery, there are two options if she has another baby. She can chose to have another cesarean section (elective c-section), or she can decide to give birth vaginally, called a VBAC (vaginal birth after cesarean).
A VBAC is an important decision but one that may not be easy to make. While the risks might be serious, they are rare. But are they really dangerous?
Let’s rewind back to the reason why a mom has a cesarean birth in the first place. Was baby breech or not in a good position? Did the mom’s cervix not dilate and labour didn’t progress? Was the baby in distress? Was it an emergency c-section? What kind of incision was made into the uterus? How long ago was the c-section? Has the mom had a previous vaginal delivery before a c-section? All of these factors impact whether or not the mom would be a candidate to try for a VBAC, how likely it would be a success, and how risky it would be. All these questions must be discussed with your health care provider in order to make an informed decision.
The surgical incision made to the uterus during a C-section results in a scar. During labour, the uterus contracts and pressure is put along that scar. The major concern is that the uterus will break open (rupture) along that scar. Uterine rupture is the number one risk for a vbac. If this occurs, it can be detrimental for the mom and the baby. Uterine rupture is rare and accounts for less than 1% of women attempting a VBAC. While this number is quite low, the outcome is life threatening.
Trying for a VBAC does not guarantee it will be successful either. Approximately 1 in 4 women attempting a VBAC will end up with a cesarean birth. This can impact a moms mental health if it is not successful, resulting in her feeling like she failed. She might have birth trauma from the previous c-section, which she may want to prevent from occurring again. A scheduled c-section may be a better option for her emotional well-being. Mental health is so important and must be considered when making this decision.
So why consider a VBAC if there is a risk? The hospital stay is usually shorter and there are no post operative complication to be concerned about as it does not involve major abdominal surgery. Also, the recovery time is shorter, allowing the mom to return to daily activities quicker. For others, they may want more children and vaginal deliveries will allow for less complications. Undergoing multiple C-sections can cause future health risks such as bladder or bowel injury, problems with the placenta in future pregnancies. If the mother knows she wants more children, knowing this information can help make the decision in whether or not to attempt a vbac.
How can you navigate a vbac safely? Ensure your health care provider has all your up to date medical records, including the operating room report on your c-section or any other uterine procedures. Also, plan to delivery your baby at a facility that is equipped to perform c-sections. Lastly, be open minded and flexible. Be sure to discuss all your concerns with your health care provider, and weight the pros and cons. This is your body and your birth experience. Our baby’s are our gifts, so no matter how they make it earth-side, enjoy the journey. You Got This Mama!