Vaginal birth after caesarean (VBAC) | 5 things you should know
Earlier women who delivered via a cesarean section had no other option other than opting for a cesarean section for all subsequent pregnancies. Today, VBAC or vaginal birth after caesarean offers an alternate birthing process for women. In this article, Dr Anjali Kumar, top obstetrician and gynaecologist in Delhi NCR talks about 5 things everyone thinking of VBAC should know.
VBAC is not suitable for every expectant mother
Before opting for VBAC, you need to assess if it is the right option for you. Some risks can make it an unviable birthing option. There are several factors that decide if you are an ideal candidate for VBAC. These include:
The type of uterine incision used for your previous C-section
The three types of uterine incisions used for C-sections are low transverse, low vertical and classical uterine incisions. VBAC is usually done only on women with low transverse or low vertical uterine incisions. A high vertical incision or classical incision is associated with a higher risk of uterine rupture.
History of uterine rupture
Uterine rupture is a rare but severe complication that can occur in pregnancy. It causes the uterus to tear which can allow the fetus to slip into the abdominal cavity. Women with uterine scars due to previous caesarean sections are at a higher risk of developing this complication. If you have a history of uterine rupture, you would not be considered an ideal candidate for VBAC.
Previous surgical procedures on the uterus
If you have undergone any surgical procedures on your uterus in the past such as fibroid removal, you would not be considered for VBAC. Previous surgeries can cause uterine scarring which is not ideal for VBAC.
Number of previous C-sections
VBAC is not recommended for women who have had more than two C-sections previously.
Time lapsed since your last delivery
VBAC is not recommended for women who have undergone a C-section delivery less than 18 months prior.
Presence of any underlying condition
If you have any other underlying condition such as placental problems or multiple births, which can complicate your pregnancy or labour, you would not be recommended a VBAC.
Other factors such as being overweight, breech presentation of the baby, size of the baby etc can also result in VBAC being ruled out. Discuss your suitability for VBAC at length with your obstetrician early on in your pregnancy so you can start preparing for your labour.
Not all hospitals and doctors offer VBAC
While you may be keen to explore the option of vaginal birth after caesarean (VBAC), the fact is that not all hospitals or doctors offer this birthing option. While complications arising from VBAC are rare, hospitals and doctors need to be prepared to perform an emergy C-section during TOLAC (Trial of labour after cesarean). Constant fetal and maternal monitoring is also essential during this process. Hence, if the hospital or doctor is not experienced in handling difficult labour, they may not offer VBAC as a birthing option. Deciding to switch your hospital and doctor later in the pregnancy can be tough. Hence, choose your hospital and doctor after exploring these options carefully, early on in your pregnancy.
There are several benefits associated with VBAC for both mother and baby
In the past few years, there has been a sharp increase in the popularity of VBAC. Many expectant mothers wish to explore this birthing option due to the number of benefits associated with it. Lower recovery time, lower risk of infection from the surgery, shorter hospital stay and lesser pain are some of the advantages of VBAC for the mother. Even for the baby, passing through the birth canal helps squeeze the fluid from his/her lungs as well as transfers good bacteria, providing him/her valuable immunity after birth.
VBAC is ideal for women who wish to have more than 3 children
A lesser-known fact about caesarean section is that it is not ideal for women wishing to give birth more than 3 times. As repeated cesareans can cause several complications and uterine scarring. Each consecutive c-section poses a greater risk than the previous one. In such a scenario, talk to your doctor about your birthing options.
Vaginal birth after caesarean (VBAC) also has several risks
Like any other medical procedure, VBAC also has several risks associated with it. This is one of the major reasons why it is not ideal for everyone, nor is it offered by all medical institutions and doctors. Complications arising from VBAC are rare, also because the candidate for VBAC is screened thoroughly to minimise their risk factor.
During a VBAC, there is a small chance that the previous uterine scar breaks open. This occurs in less than 1% of all VBAC deliveries. In such a case, an emergency hysterectomy might have to be performed. There is also a chance that the VBAC attempts have to be abandoned midway due to maternal or fetal health. Emergency C-sections is performed in such a scenario.
If you have assessed your suitability for VBAC, start preparing for it early on. Speak to your doctor at length about steps you can take to have a healthier pregnancy and reduce the risk of developing pregnancy complications. Ensure that your hospital is equipped to handle complications during childbirth and also has a good NICU. Speaking to other women who have also undergone VBAC can help you manage your expectations and be better prepared.
For more information about prenatal care and birthing options, you can consult Dr Anjali Kumar at the CK Birla Hospital.