Vaginal birth after cesarean: All you need to know

Is Vaginal birth after cesarean possible? 

There so no one answer that fits this question, it depends on the case, and we can’t generalize. During my years of practice, I witnessed many cases where my patients had a vaginal birth after a c-section. In other cases, this wasn’t possible. If the reason the mother underwent a c-section the first time is a permanent one such as having a narrow pelvis, a VBAC won’t be possible, and each delivery will have to be through surgery. Also, in case of labor didn’t start naturally and the mother was not responsive to inductions, making the c-section the only mean of delivery, the second birth will likely be through surgery as well.

However, if the reason for the c-section is temporary and circumstantial, such as a breech baby, and in the next pregnancy the baby’s position is suitable for a vaginal birth, then it is possible that the baby can be delivered vaginally. Also, in case the first pregnancy was multiple pregnancies and c-section was the best option, but in the second pregnancy the mom is having one baby, then VBAC might be possible too. 

Factors that increase the possibility of VBAC

• The mother's willingness to go through VBAC

Often moms who undergo a c-section are afraid to try a vaginal birth. So, the doctor can’t attempt the vaginal birth without the mom being on board to have this experience. There is a 1% chance of the VBAC not being successful, because of the tear in the c-section incision during labor, or due to other reasons, hence the performance of a second c-section.

• Going to the hospital at the earliest stages of labor

I recommend that the moms who want to attempt having a VBAC, after the confirmation of their doctor of course that it is possible, not wait at home during labor. And to head to the hospital at the earliest signs of labor to receive full medical care and attention.

• Having a lateral c-section incision 

It is common to have a vertical c-section incision during emergency c-sections, and this makes a VBAC impossible. We can attempt a VBAC only with a lateral incision.

Possible complications of vaginal birth after cesarean

Tearing in the c-section incision can lead to rupturing the uterus. This can endanger the baby’s life, and the mother’s as well from excessive bleeding, especially if she didn’t go to the hospital early to receive proper medical observation and care.

Recovery after VBAC

After the VBAC, the doctor checks if the incision is still intact, to make sure there is no need for any medical intervention. In case there are no complications, and the incision is intact, the recovery is similar to any recovery after vaginal birth, as I explained in detail in my article on postpartum care.

Important information

•  It is noteworthy that attempting a VBAC, is usually done when a woman expresses her desire to have more than two children. But in case, the mother wants to stop having children after the second baby, we don’t recommend attempting a VBAC, to avoid any possible complications, and we recommend having a second c-section. Having two cesarean births doesn’t usually generate complications, the same as having three or four.
• It is essential to wait two years after a c-section to attempt and have a vaginal birth. This time allows the body to properly recover and decreases the chance of the incision opening up in case of vaginal birth.
• A woman who had a successful VBAC, can have other vaginal births if there aren’t any medical reasons that prohibit that.
• I recommend that women try to have a VBAC, in case there aren’t any medical limitations, and especially if there is medical care and observation available before delivery and during labor. It is noteworthy that epidurals and mild induction can be used during a VBAC if there are normal contractions.

 

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