Childbirth is a miraculous event that happens daily, yet is still almost impossible to describe. The journey for each woman is unique, from conception to delivery. When we find out we are pregnant, the questions to consider become overwhelming. You not only have to worry about yourself, but also the baby inside. This can alter your world a little, or a whole lot.
One question that will have to be answered is your delivery plan. The possibilities are endless, from delivering in a hospital to at home with a midwife, it really depends on your personal decisions. Another part of the journey of pregnancy is the need to be flexible. While you may have a plan set, this doesn’t set the tone for what may ultimately happen. At the end of the day, your labor may be nothing like you expected. For many, this means that instead of a vaginal birth, a C-section may be the best option for the healthiest delivery for you and your baby.
Many women are left to ask, can I have a vaginal birth after cesarean (VBAC)? The answer may not necessarily be straightforward, but there are great possibilities.
Who’s Eligible for VBAC?
For many who have experienced a C-section in the past, they wonder if there is a possibility they will be able to experience a vaginal birth. This is called vaginal birth after cesarean or “VBAC”. In the past, there was a misconception that once you had one C-section, every delivery after that would have to also be a C-section. While for some this may be the truth, in general, it is quite the misconception.
For every 1,000 women who attempt VBAC, approximately 1% will experience uterine rupture. Although the percentage is very small, some women don’t want to risk it.
Also, if your previous scar is vertical, you cannot attempt VBAC. When it comes to C-sections, a low transverse, also known as a Bikini Cut, is a common procedure. This means that the surgical cut is horizontal and low on the uterus. This form of C-section is most common because it creates a stronger scar which lowers the risk of any tears. Whereas, when the scar is vertical (which is not as common these days), there is a high chance it could rupture. So, most doctors won’t take that chance.
What Are the Risks of Natural Birth After C-section?
While there is a success rate for 60-80% of women to experience natural birth after a C-section, there are still risks that should be considered. When it comes to your delivery plan, it is most important that you are open and honest with your healthcare provider. Your doctor will not only listen to your needs and desires, but they will be able to see the larger picture and provide insight on what would be best for you and your baby. There are situations where VBAC may be less likely, and situations where the risks may lead to another C-section becoming your best option.
These less-likely situations include:
- Pregnancy is complicated. The factors involved can be numerous and sometimes unpredictable. There are certain conditions that may have happened in previous pregnancies that are likely to carry into others. This could include having a higher heart rate, or a risk of elevated blood pressure or sugar levels.
- Your overall health can impact your ability to deliver vaginally. Certain BMI levels, especially those over 30, could impact the ability to have a VBAC.
- High Blood Pressure. This is a condition that often shows itself after 20 weeks but could ultimately happen at any time. This is when the mother’s blood pressure is exceptionally high to the point where there runs the risk of certain organs not working properly. This can impact not only the mother, but the child as well.
- Large Baby. If the baby is measured larger in size, it may be harder to have a successful VBAC. Your healthcare provider may suggest that a C-section might be your best choice.
- Age is another major factor. It is natural to assume that a younger body is a healthier body (though that isn’t always the case!) In general, many women over 35 have a harder time trying for a VBAC after having a previous C-section.
- Location can also play a major factor. You’ll have to consider if your location is able to handle a potential emergency C-section. Delivery always has a level of unpredictability but trying for a VBAC after a prior C-section can be even more unpredictable. It is suggested that any attempted VBAC happen at a capable hospital.
While these circumstances may point to instances where you may find it harder to have a VBAC, that doesn’t mean that these conditions show that it is impossible. These instances show the importance of working closely with your healthcare provider. Together, you can gauge your potential risks and keep an eye on what needs to be watched for. While there are less likely situations, there are also situations where a VBAC may simply not be the right choice for you.
These circumstances include:
- Having a C-section in the past, especially if this was a high vertical C-section. Commonly, most medical providers choose to do a low horizontal C-section, which usually amounts to less cutting through muscle, as well as less bleeding and risk of complications during healing. With how unpredictable delivery can be, some surgeons must opt for a high vertical C-section. This surgical site can be harder to deal with when trying to deliver VBAC.
- Uterine rupture. This complication can be quite rare, but when experienced, it can greatly impact your ability to deliver vaginally. This condition can often lead to additional surgeries, which is another complication that can impact your overall chances.
- Your health can greatly impact not only your baby’s health, but your ability to deliver vaginally. There are many factors to consider. These include diabetes, heart disease, herpes, or placenta previa — which are all conditions that often make a C-section necessary.
Benefits of VBAC
Your delivery is your unique experience. There are plenty of paths to take, each path having its own range of benefits and risks. If you’ve considered VBAC, you may have already encountered the different potential benefits of choosing this path over having another C-section.
These benefits include:
- No surgery. This may seem obvious, but not having to go through extensive surgery is a huge benefit. Delivery is an ordeal. You’re bringing a new human into this world, and that alone is overwhelming and takes a toll on your body. Surgery is an added toll that, when possible, is best to avoid. VBAC removes the added complications of surgery, which can mean a faster time frame in which you can feel more like yourself and fully capable of caring for yourself and your child without additional support.
- Shorter recovery time. Any surgery is going to add time to your overall recovery. VBAC has a much faster healing period than a C-section. With proper care, you’ll be able to bounce back in no time.
- Less blood loss. Another complication with surgery, blood loss can greatly impact your overall health and recovery following childbirth.
- Lower infection risk. No need for intense surgery means that there is a much lower chance that you risk infection following your delivery.
- Family size possibilities. If you are only considering having 1-2 children, you may not be as concerned about the general risks that come with multiple C-sections. If you are looking to have a large family, this may be more at the forefront of your mind. When it comes to wanting a large family, the less complicated the better. With VBAC, you face a lower risk of complications in general.
- For many, the experience of having a vaginal birth means the world. It isn’t selfish to want to have the delivery you want. At the end of the day, it is important to have your desires in mind, but to also be flexible to the unpredictability of the experience.
Risks of VBAC
Life is full of risks, and anyone on the path of pregnancy, no matter what stage, understands this. There is no reason why you can’t strive for VBAC if that is what you want. With a caring healthcare provider, you can find ways to increase your rate of success. You can also take steps to improve your chances, such as switching to a healthier lifestyle that can increase your likelihood of success. The journey may still be unpredictable and include some risks.
These risks include:
- C-section. Even if you do everything within your power to increase your chance of VBAC, you may still ultimately need to have a C-section. It is important to understand that this is a possibility and to not let it discourage you. At the end of the day, holding your healthy baby in your arms is what matters most.
- Your Body. VBAC comes with its own set of complications, and this includes potential risk of infection, injury, and levels of blood loss depending on the level of complications.
- Uterine Ruptures. As mentioned before, this instance may be rare, but they are still life-threatening and should be taken seriously.
How to Prepare for a VBAC
When it comes to preparing for a VBAC, there are plenty of tips for normal delivery after a cesarean. VBAC is entirely possible, and you have a great potential for a normal delivery after a cesarean.
Some of these tips include:
- Your health care provider should not only be supportive of your desires, but they should also be able to be realistic with their expectations. You want to have a provider that truly cares about you, your desires, and your baby. Your provider will know not only your needs, but also your medical history, and what will be best for you and your child short- and long-term. A great health provider can help you understand your risks what steps you need to take to improve your chances of a successful VBAC.
- Childbirth classes can be a great asset when it comes to understanding what to expect with a vaginal birth. These classes can cover a wide variety of scenarios and methods to keep you calm and focused while going through delivery.
- While we want to cling to all the happy images that pregnancy and delivery may stir up, it is important to understand just how complicated this process can be. Delivery is complicated and can often take you by surprise. The more flexible you are, the greater chance you’ll accept whatever path ultimately works best for you and your baby. Understanding the complications is also key to being as fully prepared as possible.
- As previously mentioned, it is more highly recommended that you consider delivering in a hospital when it comes to a VBAC birth. The additional complications are undeniable, and it is important to be in a location that can handle an emergency if completely necessary.
Is VBAC for Me?
Pregnancy and delivery are beautiful things. While beautiful, it is also complicated. If you’ve had a cesarean in the past and you’re wondering if you’ll ever be able to experience a vaginal birth, there is a great chance this can be a real reality for you. You’ll want to work closely with your medical provider. They can give you the best insight into your abilities as well as risks. You’ll want to strive to be the healthiest you possible. You also need to be willing to be flexible and accept that whatever route you need to take, what matters most is the health of you and your baby. Each journey is different, but what ties them together is the beauty of a new life.