Are You Considering a VBAC?

Already had a c-section and preparing for baby number two’s arrival? If you’re wondering about the best way to deliver, we’ve got you covered. OBGYN Dr. Gleaton explains VBACs, eligibility, risks, benefits, and more in this article.

By Dr. Kenosha Gleaton

Are you preparing for baby number two and wondering about the best way to deliver? Well, if your first baby was born via Cesarean section (c-section), you are likely quite familiar with the term VBAC (vaginal birth after Cesarean). And whether your c-section was planned and coordinated, for instance for breech presentation, or a last minute whirlwind due to a drop in fetal heart rate, chances are you’re wondering the same thing. Can I have a vaginal delivery? And if so, should I? Is it safe? 

Let’s dive head first—that's vertex in OB lingo—into this topic and explore more. 

What is a VBAC?

A VBAC is a term used to describe a successful vaginal birth after a prior cesarean delivery.  Currently, over 31% of US babies are born via Cesarean, which makes VBAC a common topic for discussion. A much less common, but equally important, term is TOLAC (trial of labor after cesarean). This term is most appropriate when referencing a woman's plans to attempt a vaginal birth after cesarean. Once that goal is achieved, it is then considered a VBAC. 

How common are VBACs?

According to ACOG, 60 to 80 percent of women who attempt vaginal birth after cesarean section are successful. So most OBGYNs are cautiously optimistic when discussing this option with patients. That success rate, however, depends on certain obstetric characteristics. The most significant predictor of TOLAC success is a woman's cervical exam, yet there are many other contributing factors. Variables that negatively affect TOLAC success include: 

• Increased maternal age
• Increased Body Mass Index (BMI)
• Increased fetal birth weight
• Pre-eclampsia
• Short interpregnancy interval (< 19 months)
• No prior vaginal deliveries

Who is eligible for a VBAC?

The good news is that most women with a prior c-section are eligible to attempt a VBAC! And while there are some risks involved, national statistics demonstrate a  VBAC success rate of approximately 75%. However, certain women are not VBAC candidates due to circumstances that pose greater risks. These include those with:

• Prior Classical or T shaped uterine incision (often performed during premature births)

• Prior uterine rupture

• Prior extensive uterine surgery (most often fibroid removal)

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Benefits of VBACs

Because VBACs offer many health advantages for both mom and baby, it's important to discuss this potential option with your OBGYN. VBAC benefits include decreased risk of infection, deep vein clots, and hemorrhage. In addition, recovery is typically faster and leads to less significant complications with future deliveries. Babies often adjust more quickly after vaginal birth and require less respiratory support. 

Risks associated with VBACs

Although the risk of serious complication for appropriate VBAC candidates is less than 1%, that risk is mainly attributed to a condition known as uterine rupture. This occurs when the dynamic forces of uterine contractions cause the uterine scar to separate. This can lead to significant complications including: 

• Internal bleeding and hemorrhage
• Need for emergency Cesarean
• Fetal distress (abnormal fetal heart rate)
• Stillborn
• Maternal death

Can any OBGYN perform a VBAC, or do you need a specialist?

Although all OBGYNs are trained in attending VBACs (which, when successful, is like any other vaginal delivery), some have elected not to offer VBACS often due to fear of complications or  hospital restrictions. If VBAC is important to you, inquire about this option prior to establishing care with your OBGYN. If you're already established with a doctor or hospital that does not offer a VBAC option, it is not uncommon to arrange for transfer of care for delivery if feasible. 

How to prepare for a VBAC

In preparing for a VBAC, there are a few things to keep in mind:

1. Be prepared to relinquish control. Sometimes no matter how badly you desire a VBAC, it won’t happen. The sooner you accept this, the more enjoyable your birthing journey will be. 
2. Focus on maintaining a healthy weight and limit weight gain.
3. Stay on top of chronic diseases by taking medications as prescribed.
4. Engage in regular physical activity if approved by your doctor.
5. Avoid induction of labor unless there's a clear medical indication.
6. Envision your successful VBAC through positive affirmations.

The most important goal

Deciding how to birth your baby is no small feat and requires consideration of multiple factors. Make a point to actively engage both your support person(s) and your OBGYN to ensure you’re making the best decision considering your particular risks and likelihood of success. Upon completion of this process, rest in knowing that whatever your acronym—CS, TOLAC, or VBAC—it’s perfectly suited to achieve goal # 1—a healthy baby!