VBAC, or Vaginal Birth After Cesarean, is when someone can vaginally give birth after having a previous surgical birth, otherwise known as a Cesarean Section. Many providers will tell someone that they cannot safely have a vaginal birth after one or two cesarean sections, and that is not the case. There are risk factors and things to consider, but typically, when someone is a candidate for a VBAC, it is safer for them to have a vaginal birth than it is to have a repeat Cesarean surgery.
Do You Qualify for a VBAC?
When considering a VBAC, there are a few things that can make you more of a candidate and more likely to have a successful vaginal birth. One of the biggest things talked about is how many cesarean sections you have had and if you have ever had a prior vaginal birth. The consensus is that one or two cesarean sections have about a 70-80% success rate with a VBAC success. More than one or two prior cesarean sections can lead to higher risk factors and less of a chance of a successful VBAC.
Other things to consider are if you have ever had a prior vaginal birth, having a history of a successful vaginal birth gives you a higher odds of having a successful VBAC. Some studies also show age to be a factor in the success and safety of trying for a VBAC, stating that individuals who are under the age of 35 typically have more success and fewer complications during a VBAC. Another significant consideration to take into deciding on whether or not to have a VBAC is your incision type. The safest way to have a VBAC is if you have a horizontal incision type. Vertical/Classic or T-shaped incisions are not safe for a VBAC due to putting individuals at a higher risk for a uterine rupture. Other things that are not encouraging for having a VBAC are having a previous uterine rupture or having last uterine surgeries. These two things increase your risk significantly and should be taken seriously when considering trying for a VBAC or not.
Other Considerations
It is also essential that the reason for your first cesarean section is no longer present. Suppose the reason for your first cesarean section was abnormal heart tracings, breech position, or even failure to progress. In that case, likely, you could successfully have a VBAC since these things typically are not a problem for every baby. In some cases, a provider will tell someone that they have insufficient pelvic size, and to this, I would say … maybe. Maybe your pelvis is not big enough to birth a baby, or perhaps you were forced to be in a position that did not help with pelvic outlet size or were being cared for by a provider who was not giving you or your baby the time to progress. Cases of insufficient pelvic size are rare, so if this were the reason you were told you needed a cesarean section, I would highly recommend you get a second opinion.
If you are qualified to have a VBAC, the next thing you need to consider is if you want one and if you feel that the benefits outweigh the risks. If you choose to get another cesarean section, it is essential to remember that you are choosing surgery and that with surgery can come complications. Cesarean sections can also cause placental issues in future pregnancies, and some doctors will not recommend that you have a large family because the risks go up with every cesarean section that you have.
What Are the VBAC Risks?
On the other hand, there are risks with having a VBAC. The complications that can occur with a VBAC are much less than the complications that can occur with a repeat cesarean section, but they are still essential to know and talk about. The most considerable risk of a VBAC is uterine rupture. The chances of having a uterine rupture are low, occurring in less than 1% of all VBAC births, but a uterine rupture is a life-threatening situation for both the birthing parent and their baby. In cases of a uterine rupture, an emergency cesarean section would be performed, and the risks of an emergency cesarean are in the possible need for a hysterectomy, which would make it so that you could not get pregnant again. As stated above, these things are not every day, but when they occur, it can be heartbreaking, and that is why knowing all of the information is an essential step in deciding how you will choose to give birth this time.
Like most things with birth, this is only a decision you and your partner(s) can make. Now you have the information to consent to a VBAC or Cesarean Section with full knowledge of what both entail and the risks and benefits of either option.
Finding a VBAC-friendly Provider
To move forward with a VBAC, you must find a VBAC-friendly provider. These can be hard to find, but there are websites like VBAC Facts or VBAC links that have a list of providers they would recommend based on others' positive experiences. Questions you could use to figure out if a provider is genuinely VBAC friendly could include asking them how many of their last ten VBACs had vaginal births, what their cesarean rate is, what their philosophy around VBACs entails, and how they feel about VBAC births. If you have a more extensive list of questions, I recommend visiting the VBAC Fact website.
Whether you have another Cesarean birth or vaginal birth, knowing your options and choosing what feels best for you will lead to a more empowered birth either way. I truly believe that birth is beautiful no matter how it occurs. The most significant differences between a traumatic birth and an empowered birth are how the family and birthing person are treated and that they knew all of the information and got to make a decision they felt good about.
