VBAC

In the scale of old wives’ tales, the old saying that ‘once you have a caesarean birth you always have to have them’ is pretty much near the top of the list! Yet, as with so many old wives’ tales, it simply isn’t true. 

Vaginal birth after caesarean section (VBAC) is the term used when a woman gives birth vaginally after having had at least one baby born by caesarean section. 

If you’ve already had a caesarean, then your chances of having your next baby vaginally are quite good, but it does depend on why you actually needed your first caesarean. It also depends on the progress of your current pregnancy.

If you needed your caesarean for a condition that hasn’t changed – such as a small pelvis – then the chances are that you’ll need to have a caesarean again. However, if you had your caesarean because of exceptional circumstances such as a breech baby, or a low-lying placenta, then your chances of having a VBAC are increased.

With the current media focus on the risks of repeated caesarean births, the advantages of a VBAC are obvious. Naturally, with a VBAC, you avoid such risks, but you’ll also have much less pain after the birth and a shorter stay in hospital. It’s also much better for baby, since s/he is less likely to have trouble breathing after s/he is born.

A VBAC differs from normal childbirth in that you will be probably be more closely monitored during your labour. Indeed, most women will be offered continuous electronic foetal monitoring; allowing both baby’s heart rate and your contractions to be measured at all times.

Most women will have a successful VBAC without any complications at all, but there is a small risk that a scar from a previous caesarean could tear. This is referred to as uterine rupture. Rupture affects only one in 200 women trying for a VBAC, but, although the risk is small, your medical team will want to watch out for it. If your baby's heart rate doesn't sound right, it could be an early sign that there is a problem with your scar.

If you’ve had a previous caesarean and have opted for a VBAC, bear in mind that all labours are unpredictable, so there’s always the chance that you might have to give up on your VBAC option. Indeed, a quarter of women, who try for a VBAC end up needing an emergency caesarean.

During a VBAC, you can have an epidural (RCOG 2007: 9; RCOG 2008) for pain relief if you want one. Some hospitals may support you using a birth pool to help you cope with your contractions.

If your doctor has ruled out the possibility of you having a VBAC, then your other option is a planned, repeat caesarean. This is usually booked for the seven days leading up to your due date, unless your baby needs to be born sooner for a medical reason. Overall, repeat caesareans and VBAC are both safe ways for you to have your baby (RCOG 2008).

As in most issues related to pregnancy, informed choice is the best way to make a decision regarding the type of birth that you want or need. During your pregnancy, you'll have plenty of time to talk to your consultant or midwife about your previous birth or births, and they will be able to help you come to a decision about how to have your baby this time around. 

If you have had a VBAC, or are hoping to please share your experiences.