Vaginal Birth After Caesarean (VBAC)
What to Expect
Information, preparation, and teamwork are needed for a successful vaginal birth after caesarean (VBAC).
Childbirth and VBAC education
To prepare for labour, consider taking a childbirth education class at your local hospital or clinic. You and your birthing partner can learn:
- What to expect during VBAC labour and delivery.
- How to manage the birth using controlled breathing and emotional and physical support.
- What medical pain control options may be available for a vaginal delivery.
Labour
Other than requiring closer monitoring, labour for a VBAC is the same as normal labour. During early labour, a woman can remain as active and mobile as she feels comfortable with. There are no specific restrictions for VBAC until active labour begins. During the active period of labour, continuous fetal heart monitoring is done to watch for early signs of fetal distress or uterine rupture. (For more information, see the Examinations and Tests section of this topic.)
- If you are attempting VBAC and you have not had a previous vaginal birth or your previous caesarean was done early on in labour, your labour will be like a first-time labour. For example, it could take a long time.
- If you have previously had a longer trial of labour or have delivered vaginally, your body is likely to have adapted to the process, making labour easier.
For more information about labour and delivery, see the topic Labour, Delivery, and Postpartum Period.
Medications for starting or strengthening VBAC labour
Some doctors avoid the use of any medicine to start (induce) a VBAC trial of labour. Other doctors are comfortable with the careful use of oxytocin (Pitocin) to start labour when the cervix is soft and opening (dilating). VBAC studies have shown that inducing or strengthening labour with misoprostol (Cytotec) increases the risk of uterine rupture.3
If your labour slows or stops progressing, your doctor may use oxytocin to strengthen (augment) contractions. The sparing use of oxytocin (Pitocin) is an accepted and common practise for a stalled VBAC trial of labour and is rarely linked to uterine rupture.9
Pain medication
As with most vaginal births, most women who choose VBAC can safely use pain medicine during labour.
Pain medicine usually is started when the cervix has opened (dilated) 3 cm (1.2 in.) to 4 cm (1.6 in.). Types of pain medicines used include:
- Local anesthesia, which numbs the small area where the medicine is injected.
- Regional (epidural) anesthesia, which partially or fully numbs the entire lower part of the body.
- Sedatives, which help you relax and sleep but do not relieve pain.
- Opioids (narcotics), which help you relax and partially relieve pain.
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| Author: | Kathe Gallagher, MSW Carrie Henley | Last Updated: June 18, 2007 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology | |
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