A question I get often is, “Do you attend VBAC’s (Vaginal Birth After Cesarean)?” The answer is a resounding “Yes.” I will attend women who have experienced one prior cesarean section with a low-transverse incision, whether or not the woman has history of a previous vaginal birth.
The likelihood of a successful VBAC are quite high: 80% of women who attempt a VBAC will be successful. VBAC has a number of benefits over repeat cesarean section. For most women, in an appropriate setting, these benefits outweigh the risks.
- elimination of operative and postoperative complications
- reduction in the length of postpartum recovery
- easier infant care and bonding
As with any birth, there are risks involved, especially when complicated by a previous uterine surgery. The main risk for VBAC’s, although rare, include uterine rupture and/or uterine dehiscence at the incision site. Five out of 1000 women will experience uterine rupture after a prior uterine incision, which is less than 1% of appropriately attempted VBAC’s. In the event of a complication arising in a VBAC at home (often called HBAC or Home Birth After Cesarean), prompt recognition, transport, and emergency management in a hospital can minimize serious consequence.
While in labor, the midwife will monitor vital signs and progress closely. She will check fetal heart tones every 15 minutes during active labor (every 30 minutes in a non VBAC), blood pressure and pulse every hour (rather than every two hours), labor progress every 2-3 hours, and she will evaluate for uterine rupture signs ongoing. An emergency plan will be in place prior to the onset of labor.
Both the National Institute of Health (NIH) and The American College of Obstetricians and Gynecologists (ACOG) support VBACs. The NIH states that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. ACOG states similarly that most women with one prior cesarean and some women with two prior cesareans are candidates for VBAC.