VBAC (Vaginal Birth After Cesarean)
Questions,
Answers and Resources
By Suzanne Sarmasti
If you have undergone a cesarean delivery, you are
not alone. In November 2005, the Centers for Disease
Control and Prevention reported the national cesarean
birth rate was the highest ever at 29.1%, which is
over a quarter of all deliveries.
Q1. Why would I consider a vaginal
birth?
A1. The reasons for this are many-fold. One may be
to avoid the possible complications of major abdominal
surgery to both mother and baby. One may be to avoid
the recovery from such a surgery simultaneous with
the physical, emotional and hormonal transformations
of the postpartum period. Vaginal birth also allows
you more participation in the birth and earlier bonding
with your baby. Your reasons could also be purely
financial, as a vaginal birth is significantly less
expensive than a C-section. If you are planning a
large family, VBAC may be an important consideration
as repeat C-sections get more complicated each time.
Q2. Is it safe? What about uterine
rupture?
A2. The most common type of uterine incision today
is the low horizontal (transverse) incision, which
is far less likely to compromise the uterus than the
classical (vertical) incision. Unregulated use of
pitocin to stimulate labor, use of high forceps and
other aggressive labor management actions can lead
to complete uterine rupture irrespective of past cesarean
or not. The risk of uterine rupture is less than 1%,
and does not always have complications (benign rupture).
In addition, there is no proven higher incidence of
rupture among VBACs!
Q3. Is my pelvis too small or
baby to big?
A3: Unless you have had a trauma to your pelvis,
or a disease that affected your bones, such as polio
or rickets, it is extremely unlikely your pelvis is
inadequate for childbirth. Even early prenatal measurements
of your pelvic dimensions will shift as your ligaments
relax. A large baby (over nine pound) does not mean
the head will not mold and move to fit through the
birth canal. ACOG (American College of Obstetrics
and Gynecology) states that the effects [or difficulties]
of labor with a baby more than 8 ¾ lbs have
not been substantiated In fact, many mothers say their
larger children were easier births, as if they were
using their further developed bodies to muscle and
maneuver the way out.
Q4: What are my chances of success?
A4: 80% of attempted VBAC’s are successful
vaginal deliveries- which is a higher rate than non-VBAC’s!!
Though, as with any birth or anything in life, we
have to approach it with flexibility because some
factors will always be out of our control. As you
do your mental, physical and emotional evaluation
of whether or not VBAC is for you, consider how you
will feel/deal if your labor ends in a repeat C-section.
Online Resources
http://www.ican-online.org/
http://www.childbirth.org/section/VBACindex.html
http://www.mothering.com/articles/pregnancy_birth/cesarean_vbac/cesarean_vbac.html
http://www.mayoclinic.com/health/vbac/VB99999
Print Resources
Diana Korte and Roberta Scaer: Good Birth, Safe
Birth
Nancy Wainer Cohen and Lois J. Estner: Silent
Knife; Open Season
Bruce Flamm: Birth After Cesarean
