Unless you have access to a doctor that can preform a French C-section, a vaginal birth after cesarean (VBAC) probably sounds very appealing to you given the long and often very painful recovery involved with a C-section. A VBAC isn’t something that every doctor can preform, however, nor is it something every woman is a candidate for. If you’ve delivered a baby via C-section and you’re pregnant again you’re probably finding yourself weighing the decision of either scheduling a repeat C-section or a vaginal birth after cesarean. To find out more about this choice we turned to Dr. Vonne Jones, MD, an OB/GYN providing care to women at Total Women’s Care, in Houston, TX.
Momtastic: In general, what are the benefits of vaginal birth versus C-sections for mums?
Dr. Vonne Jones: If you’re looking at vaginal birth in general versus C-sections, vaginal birth is going to be a quicker recovery time. Typically, the vaginal delivery is going to have less blood loss and in terms of hospital stay and different things like that, you’ll be able to leave the hospital earlier. Because C-sections are so common sometimes people fail to realise that it’s an open abdominal surgery. Whenever you have an abdominal surgery, there are risks of infection, risk of injury within the pelvis, bowel, bladder and major public vessels that feed into the uterus.
Momtastic: Who qualifies for a VBAC?
Dr. Vonne Jones: There’s what we call a VBAC calculator. It was developed by the American College of Obstetricians and Gynecologists and it gives us a protocol based on why mum had a C-section. If mum had a C-section because it was an emergency and she was in labour and dilating and progressing well and baby’s heart rate dropped and despite all of the normal precautions and measures, the baby’s heart rate was still down, that would be an indication that you could at least try labour. If you had a C-section because of complications that sometimes arise during pregnancy, then you would also be a candidate for VBAC back.
If you have had a C-section and delivered a premature baby and you have a vertical incision on the uterus, then a VBAC would not be possible. Or if you’ve had any type of uterine surgeries (fibroids are the most common reason why you have a uterus surgery) then it’s also not an option. Also with twins you would not want to do a VBAC because you don’t want that pressure on that the uterine scar as it could open or rupture. Placenta previa, basically when you’re having the placenta kind of cover the cervix, that also would eliminate the option of a VBAC. Lastly, babies in a breech position that means the bottom are first or it could be footling breech meaning that the feet are first, that is not an indication for a vaginal delivery.
Typically if you put all of these different things in place, the calculator will give you a score and a score of 75% or up is associated with a higher success rate of the VBAC. But these things are all things that could potentially change depending on what’s going on during the labour process.
Momtastic: What are the possible complications involved in a VBAC?
Dr. Vonne Jones: The biggest difference between a VBAC and someone that’s just coming in for a vaginal delivery is you could potentially induce someone that has never had a C-section before. If you’ve had a C-section before you can’t do it because it can increase the risk of uterine rupture, which is the major risk factor that that can occur for mums that are trying for VBACs.
Momtastic: Is a VBAC more painful?
Dr. Vonne Jones: Typically you’re going to have the same pain you would if you were trying for just a vaginal delivery. If you compare VBAC versus C-sections, a C-section is going to be more painful. But sometimes what can happen is if you try for a VBAC and it doesn’t work, and you end up having to have a C-section, that whole process can be more painful.
Momtastic: Is it potentially safer than getting another C-section?
Dr. Vonne Jones: It could be for patients that are successful, but not if they try for vaginal delivery and end up with an emergency C-section. That would not only be more painful, but could potentially lead to more risks during the actual surgery itself.
I will say with the VBAC if you’re the appropriate candidate, then it is something that we see success in, it’s just finding that candidate and kind of walking with that patient during the process of pregnancy.