If you are pregnant again and your previous child was born through cesarean section, you might question if vaginal birth is an option for you this time. Many women can have a vaginal birth after a C-section (VBAC), but there are several variables that can help you and your doctor decide if it is suitable for you.
The most important factor to consider is your and your baby’s safety. VBAC is not always safe for all women.
If you attempt a vaginal birth and are at high risk of complications, it can result in major problems for you and your baby, some of which are life-threatening. That is why you should discuss the dangers with your doctor.
Know the state of your health?
Both you and your baby must be in good health for you and your doctor to explore a vaginal birth for you. If you are pregnant with twins and your doctor feels you are all healthy enough, you might be eligible to try VBAC.
Your doctor may advise you that VBAC is too dangerous for you to have a successful vaginal birth. Any of the following risks could occur:
- Obesity (your body mass index is 30 or greater)
- Preeclampsia (high blood pressure during pregnancy)
- Age (typically older than 35)
- Your previous cesarean was performed within the last 19 months.
- The foetus is enormous.
Scar from a previous C-section
The sort of C-section scar on your uterus is an important issue that you and your doctor must discuss. (This could be the same scar as the one on your abdomen, but it could go in a different direction.) During a C-section, doctors create incisions (cuts in the abdomen and uterus) in two separate directions:
- Vertical cuts are made from top to bottom.
- A transverse cut runs from one side to the other.
You cannot attempt VBAC if your C-section scar is vertical. When you attempt a vaginal birth, there is a very high danger that your scar will rupture (burst open or tear), causing serious injury to both you and your baby. If your C-section scar is low and transverse, your doctor may allow you to try VBAC if your other risk factors are modest.
Why are cesarean deliveries sometimes required?
In some cases, cesarean birth is a useful and required procedure.
- When labor does not advance because there is a concern about the baby (for example, development restriction or heart rate concerns during labor).
- Problems with the placenta.
- A breech presentation occurs.
- when an infection or sickness, such as HIV (Human Immunodeficiency Virus) or genital herpes, could be transferred to the infant during vaginal birth.
In the United States, about one-third of all babies are born via cesarean section. If a person has had a cesarean birth, the chances of having a future baby are increased. Only 13% of cesarean patients will go on to have a VBAC. This is significant since cesarean births need more recuperation time and have a higher risk of complications.
Why is attempting a VBAC beneficial?
Because not everyone who has had a cesarean can safely undergo a VBAC, consult with your doctor about your specific case. VBAC, for example, is normally not advised for women who have had more than two previous cesarean deliveries.
VBAC has many advantages, including a faster recovery time and a lower risk of bleeding, infection, blood clots, and organ damage. If you plan to have more children in the future, a VBAC minimizes the risk of complications with the placenta — which feeds the foetus — during later pregnancies.
How do doctors determine the chances of a successful VBAC?
The Maternal-Fetal Medicine Units (MFMU) Network developed a tool in 2007 to predict a pregnant woman’s odds of a successful VBAC. Many elements thought to influence success were considered in the calculations:
- weight, height, and age
- Whether a previous cesarean delivery was performed because dilatation of the cervix dramatically slowed or stopped, or labor stalled during the pushing phase (the medical terminology is the arrest of dilation or descent).
- whether a person was being treated for excessive blood pressure prior to pregnancy.
The original calculator also took race and ethnicity into account. It specifically questioned if the pregnant woman was “African American” or “Hispanic,” and assigned a lesser chance of success than if she was white.
What are the dangers of VBAC?
A successful VBAC has fewer difficulties than an elective repeat C-section, while a failed trial of labor after a C-section has higher complications, including uterine rupture. Uterine rupture is uncommon, occurring in less than 1% of women who undertake a trial of labor following a cesarean section. However, uterine rupture can be fatal to both you and your baby. The cesarean scar on the uterus ruptures during a uterine rupture. An emergency C-section is required to avoid potentially fatal complications. The uterus may be surgically removed (hysterectomy) as part of the treatment. You will be unable to conceive again if your uterus is removed.
Who qualifies for VBAC?
VBAC eligibility is determined by a variety of circumstances. As an example:
Which uterine incision was used for the last C-section? A low transverse incision is used in the majority of C-sections. VBAC is frequently performed on women who have had a low transverse or low vertical incision. VBAC is not suggested if you have previously had a high vertical (traditional) incision due to the risk of uterine rupture.
- Have you ever experienced a uterine rupture? If this is the case, you are not eligible for VBAC.
- Have you undergone any other uterine surgeries? VBAC is not recommended if you have had previous uterine procedures, such as fibroid removal, due to the danger of uterine rupture.
- Have you previously experienced a vaginal delivery? A vaginal delivery before or after your previous C-section enhances the likelihood of a successful VBAC.
- How many C-sections have you undergone? Many doctors would not consider VBAC if you have had more than two previous C-sections.
- When was the last time you gave birth? If you attempt VBAC fewer than 18 months after your previous delivery, you run the risk of uterine rupture.
- Do you have any health issues that might prevent you from having a vaginal birth? If you have placental difficulties, your baby is in an aberrant position, or you are carrying triplets or higher-order multiples, a C-section may be necessary.
- Where are you going to have the baby? Plan to give birth in a facility that can manage an emergency C-section. VBAC does not require a home delivery.
- Will you require induction? Inducing labor reduces the chances of a successful VBAC.
How does VBAC labor and delivery differ from ordinary vaginal birth labor and delivery?
When you choose VBAC, you will go through the same process as with any other vaginal delivery. However, your doctor would advise you to keep an eye on your baby’s heart rate and be prepared to do another C-section if necessary.
What other advice do you have for ladies considering VBAC?
If you are thinking about VBAC, talk to your doctor about it early in your pregnancy. Share your fears and expectations. Ensure that he or she has a comprehensive medical history, including records of any previous C-sections and other uterine surgeries. Your healthcare physician may calculate the likelihood of a successful VBAC.
Plan to have your baby delivered at a facility that can manage an emergency C-section. Throughout the pregnancy, continue to explain the risks and benefits of VBAC, especially if certain risk factors appear.
Above everything, try to remain adaptable. The circumstances of your labor may make VBAC a perfect choice, or you and your healthcare practitioner may decide that a repeat C-section is the best option.
The Hospital Is Important
Check with your doctor ahead of time to see if the hospital allows women to pursue VBAC. Not all hospitals do.
Although the likelihood of your previous scar rupturing during VBAC is low, the hospital must be prepared to address any emergency that may occur. Some hospitals are simply not equipped to manage it.
Low vs Zero Risk
Even if a woman has a low transverse C-section scar and is in good condition, there is a small possibility that her uterus would burst if she attempted VBAC. Doctors cannot predict whether or not it will happen to you.
Even though ruptures occur in less than 1% of VBAC attempts, some women are hesitant to try because if one occurs, it can be quite risky. Before deciding what to do, you should assess your alternatives and consult with your doctor.
The Advantages of VBAC
If VBAC is an option for you and you enjoy the concept of having a vaginal birth, there are several reasons why you should try it. There is a good possibility you will succeed: Approximately 70% of women try to have their kids vaginally. Due to complications during the attempt, a C-section is required for the remainder. You may choose to try VBAC for a variety of reasons, including the following advantages if successful:
- It does not necessitate surgery.
- Blood loss is reduced.
- Recovery time is reduced.
- Reduced risk of infection
- You are unlikely to sustain bladder or bowel damage.
- You will experience fewer complications in future childbirth.
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