Heard of “VBAC,” but don’t really know what it is? Interested in having a VBAC, but need more information to make your decision? There’s too much fear around VBACs (vaginal birth after cesarean) circulating out there and slight risks (serious, but slight) are blown out of proportion. Want a repeat c-section? That’s okay, too, I just want to be sure women are making an informed decision, not one based on scare tactics.
1. About 75% of women that labor naturally for a VBAC are successful.
2. When discussing VBAC with a care provider, they’ll most likely bring up “uterine rupture” as a reason NOT to VBAC and to instead sign up for that repeat c-section. However, the risk of uterine rupture is around 0.2%. That means that 99.8% of the time, there is no rupture.
Where does the fear come from??? Back in the day, cesarean incisions were often made vertically (up and down) and higher up on the uterus – the most likely place for rupture to occur. Now, incisions (even in emergencies) are generally made low and transverse (from side to side), where rupture is very unlikely to occur. Check your hospital records and confirm the type of incision you had.
3. In a study of 36,000 women having VBACs, not even one died from uterine rupture, regardless of incision type. In a 10-year study (1988 – 1997) based on 114,933 deliveries, there were 39 ruptures (16 complete, 23 dehiscence). 37 of those 39 cases were women who had a previous c-section [10% of women in the study had a prior c/s, or 11,585 of the 114,993. That’s a uterine “rupture” rate of 0.32% for VBAC mamas]. There were NO maternal deaths, 33% of complete ruptures [=5 – 6 women of the 114,933] required a blood transfusion, and there was one neonatal death.
4. Rupture is a scary word and luckily it’s a misleading term. Even in that 0.2% of cases where it occurs, it’s not like the uterus explodes (as the term “rupture” might imply). What happens is the previous cesarean incision starts to pull apart and open. Most of the time, it’s gradual and is caught by a watchful eye (or fetal monitoring, if at the hospital).
5. CPD (cephalo-pelvic disproportion) does not mean you cannot have a VBAC. If you received this diagnosis as the reason for your first c-section, it means your pelvis was too small to fit the baby. This condition is very rare and even if you do truly have it, your next birth is likely to still be a successful VBAC. Your pelvis loosens with each birth and laboring/delivering in different positions can help open you up or allow the baby to find a way to fit through.
6. The more c-sections you have, the riskier birth becomes for both you and the baby because of all the scar tissue. Want more kids? Then you need to put a lot of thought into this decision for a repeat c-section.
7. Due dates can be off by up to two weeks, so if you schedule a c-section for 39 weeks, your baby could really be around 37 weeks. That leads to increased difficulties and NICU stays (~10% of cesarean babies end up in the NICU). Vaginal birth also helps to better prepare the baby for the outside world by effectively clearing their lungs and releasing needed hormones.
8. Have you had multiple c-sections and want a VBAC? New guidelines from ACOG state that risks for uterine “rupture” are the same (or only marginally increased) for a VBAC after two c-sections as they are for a VBAC after one c-section.
9. ICAN states (based on scientific research) that a VBAC is less risky for both moms and babies than a cesarean. RISKS of elective cesarean.
10. It’s your body, your baby, and your birth. It’s your decision. Whatever it is, be comfortable and happy with it – do not go into it with fear. Be ready to accept any outcomes from your decision (whether it’s a cesarean or a VBAC).
*I think I will do an upcoming post that’s more about VBACs vs. repeat c-sections… a more direct comparison of risks and benefits of each. Let me know if there’s anything else specific you’d like to see!