What’s the scoop with VBAC?

So you’ve had a c-section before, why not try a VBAC?

Maybe you are pregnant or thinking about it and you’ve had a c-section before.  Hopefully you have heard of a VBAC and  you are wondering what it’s all about.  Maybe you think a VBAC is some fancy vacuum and have always wondered why pregnancy sites recommend it.  Well, you have come to the right place to start figuring it out.  VBAC is short for Vaginal Birth After Cesarean Section. It’s a great idea to get informed and arm yourself with some facts.  It’s easier to make decisions that are right for you when you’ve got the scoop on things.

Is a VBAC safe?

YES.  Both a VBAC and a repeat c-section are very safe options.  They both have risks and benefits.  In the end, it just depends on doing what feels right to you.  In some uncommon instances, a repeat c-section may be the safest option.  Your care provider will be able to explain to you why that might be the case for you.  For most people though, a vaginal birth is safe.  You will have to decide if you want to schedule a c-section or try to have a vaginal birth.

VBAC fact:

Out of 100 people who plan a VBAC, 75 of them will succeed.  The remaining 25 will have a repeat c-section.  Knowing why you had a c-section in the first place is important.  Having access to your operative report will help you and your care provider discuss your option of VBAC and assess your chances of success.   Have a look at this decision aid to help you think it through.

The International Cesarean Awareness Network (ICAN) has a great FAQ on VBAC.

What makes you less likely to have a vaginal birth following a c-section?

• If you are over the age of 35
• Your body mass index is over 30
• When drugs are used to induce labour
• When the reason for your previous c-section repeats in this pregnancy
• When you decide you don’t want a vaginal birth and schedule a repeat c-section.

In the end, this is the birth process that we are talking about.  It never ceases to amaze us.  The research says that even if you have factors that lower your chances of a VBAC, you still have over a 50% chance of having a vaginal birth.  For a whole lot of people, that is definitely worth a try.

What’s the scariest part of choosing a VBAC?

The biggest risk of a VBAC is something called a uterine rupture.  Your uterus has a scar on it from where they went in to get your baby when you had a c-section.  That part of your uterus is a little bit weaker and can tear (rupture).  This can even happen to people who have never had a cesarean section.  When you have had a c-section though, your risk is higher.  Uterine rupture happens to 0.5% or 1 in 200 people choosing to have a VBAC.  Of course that also means that 99.0% to 99.5% of people choosing a VBAC will have scars that remain strong and intact.

What happens when the uterus ruptures?

A uterine rupture is an emergency.  It require a c-section to get the baby out quickly and to stop the bleeding from the tear.  It is important to know that most mothers and babies will recover completely from a uterine rupture.  In rare situations, there can be serious consequences like a hysterectomy (removal of the uterus) to stop the bleeding.  In those same rare situations, babies can suffer permanent brain damage and some babies will die from a uterine rupture.

These devastating consequences are rare and occur in less than 5% of all cases of uterine rupture.  Let’s try to clarify these numbers a bit.  Remember that only 0.5% of people planning a VBAC will have a rupture.  5% of those 0.5% will have devastating consequences.  That ends up being a super duper small number.  0.0025% to be exact, but super duper small numbers happen to someone.  The question is if you feel that this is a risk that you can live with or not.

According to the Royal College of Obstetricians and Gynecologist (in the UK), the risk of a baby dying due to a VBAC is about the same as the risk of a baby dying when someone is having their first baby.  It is also important to note however, that the greatest risk to people choosing VBAC is if they end up in the operating room for an emergency c-section.

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Quick review of the risks of c-section

A c-section is considered major abdominal surgery.  Some risks are:

• infection
• blood loss
• blood clots
• damage to internal organs (like the bladder and bowels)
• problems in future pregnancies with how the placenta attaches (previa, accreta) which in rare circumstances can cause maternal and fetal death
• babies are more likely to have breathing difficulties (labour improves the ability of the baby to breath easily after birth)
• babies born of c-sections have higher admission rates to NICU (Neonatal Intensive Care Units)

For a more detailed look at c-sections, you can check out the International Cesarean Awareness Network (ICAN) c-section FAQ section.

Some thoughts about risks…

Nothing in life, or in birth is without risk.  You live with a certain amount of risk every day of your life, pregnant or not.  You have grown accustomed to some of the risks that surround you and probably barely think about them.  Carrying another human being in your body who is completely vulnerable and depends on you for survival, can make you feel the weight of risks differently.  I have never met a family who wanted to put their child at risk.  Understanding that every choice you make carries risks is helpful.  Knowing that both your choices have been well studied and found to be equally safe is also helpful.  Giving your body a chance to do what it was designed to do: priceless.

I am so grateful to be living in Canada, and more precisely in Ontario.  Hospitals are all around us and well equipped to handle emergencies in childbirth.  With careful planning and considerations, a VBAC is safe.  As safe as anything can ever be.  Even with modern technology we will never be able to prevent every injury or death associated with birth. C-sections are also safe and also can, in rare circumstances, lead to maternal death. Injury and death in childbirth has always existed and always will.  There are other risky things in birth that are statistically more likely to happen than a uterine rupture.  Shoulder dystocia, cord prolapse and placental abruption are all more common and can be just as catastrophic.  In the end, like RCOG stated, you are at no bigger risk of your baby dying than anyone having their first baby, and people do that all the time!

Benefits of VBAC

• shorter hospital stay
• less pain
• quicker recovery
• reduced blood loss
• safe for you in this pregnancy, and much safer for you in future pregnancies

For some, the benefits of VBAC are more than just physical harm reduction.  It is also about emotional and psychological healing.   For many, the previous experience of birth may have left more than just physical scars.  It often leaves emotional ones as well.  Some people experience their c-section birth experience as traumatic and are now seeking a healing experience.  They want to know that their body, when given time and a proper chance, can do what it is meant to do.

I have met so many people who have come into my office and cried with sadness and pain when telling their birth story.  Not usually because it ended in a c-section but because they felt powerless.  They often feel like they did not know they had choices and options.  Families wonder if they had done things differently,  could they have avoided the c-section?  The birth parent often does not feel like they did everything they could to have a vaginal birth.

These families often plan a VBAC and try to heal from their past experience.  They may not end up with a vaginal birth but they will often tell us that they feel healed, despite another c-section.  When I ask them why they feel good about their c-section and birth this time around, they will often say that it is because they felt in control.  They got to make the choices, they knew the facts, they did what they could to try and put all the chances for a VBAC on their side.  That is a good feeling to them.

A little bit of love for VBAC

Acorn and Oak Photography

One cannot underestimate the power of birth.  What it brings to you, other than a healthy birth parent and baby is often so difficult to describe.  Once you have lived it, you will know what I am talking about.  Our job as a midwives is to help you achieve your best birth, whatever that is to you.  We do that by giving you the information you need so that you know how to have the best chances of achieving your best birth.

When you feel powerful in your choices, we have done our job well.  Your midwives will remind you of the beauty, magic and power of the birthing process.  Then our job is to support you in your choices, whatever they may be.  In the end, the choice is always yours. Midwives are not there to judge you for it one way or the other.  We are there to love you up, whatever you choose.  If you are happy with your birth choices, then we are happy.

Josée Nolet is a registered midwife with Generations Midwifery Care. You can learn more about Josée here and here.