Vaginal Birth After Caesarean (VBAC)

What to Think About

Any woman in labour—not just one attempting a vaginal birth after caesarean (VBAC)—might develop complications during childbirth that require a caesarean section delivery.

If there is no medical reason for a caesarean, vaginal delivery is generally a safe option for both mother and baby. It is common, however, to fear going through labour after having had a caesarean delivery. This is especially true for women who have attempted a vaginal birth but, after a long and difficult labour, ended up delivering by caesarean.

Benefits of a successful VBAC include:

• Avoiding another incision in the uterus. If you are planning on a pregnancy after this one, scarring is an important factor to think about. After you have two scars, each additional scar in the uterus raises the risk of placenta problems in a later pregnancy, such as placenta previa or placenta accreta. These problems raise not only the risks for a fetus but also your risk of needing a hysterectomy to stop bleeding.¹⁰
• Less blood loss.
• A lower risk of infection after childbirth (though for women who are obese, infection risk is higher after a VBAC than after a caesarean¹¹).
• A lower risk of blood clots (deep vein thrombosis).
• Greater participation in the birth.
• A quicker recovery.

The ultimate decision to try a vaginal birth is made by you and your doctor. If you want to try a VBAC, but your doctor is not in favour of your choice without a clear reason, consider getting a second opinion.

Should I have a VBAC trial of labour after a previous caesarean?

If you are considering VBAC, talk with your doctor about:

• The risks of vaginal and caesarean deliveries in your particular case. Here are some points to keep in mind:
  • Serious complications with either vaginal or caesarean births are uncommon.
  • A caesarean section is a surgical procedure and requires the use of anesthesia. Any surgery carries a risk of infection, excessive blood loss, and problems caused by the anesthesia.
  • Women who need a caesarean after a VBAC trial of labour have a higher rate of infection than those who have a caesarean without a VBAC trial of labour.¹
• Whether your doctor will be available in the hospital throughout your labour and whether the hospital has facilities for an emergency caesarean delivery.
• The possibility that a trial of labour may end in caesarean delivery.
• How and at what point during labour the decision is made to do a repeat caesarean.
• Which types of pain medicine or anesthesia you may use during labour and delivery or a caesarean.
• Your particular risk factors for uterine rupture during VBAC and the possible complications of a rupture, such as removal of the uterus (hysterectomy).

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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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