What is a VBAC?
VBAC stands for vaginal birth after caesarean. In a VBAC, the mother had a cesarean section delivery and then in a later pregnancy attempts to deliver vaginally. A VBAC can be done safely, but it is important that the nurses and doctors be very vigilant. There are many risks associated with a VBAC, including but not limited to uterine rupture and bleeding risks. A successful VBAC however, is associated with decreased risk of maternal morbidity and future complications in future pregnancies (Asgarian et al, 2019).
Why Consider a VBAC?
Given the risks, why do some women consider having a VBAC? There are several reasons, including the following:
An emotional investment in a vaginal birth. Some women desperately want a natural birth experience and, if their first delivery was a C-section, they want to at least try for a vaginal birth the next time.
Quicker recovery. A vaginal birth with no complications means a shorter hospital stay and a faster return to normal activities, something that is particularly appealing to women who already have a child at home.
Avoids surgery. All surgeries carry risks and the desire to avoid these risks leads many women to attempt a VBAC. If their first C-section was difficult, they might also wish to avoid a repeat of a traumatic experience.
Considering more children. The more C-sections you have, the more damage you do to your uterus and the risk of bowel injury and placenta problems is increased. If a woman is planning to have several more children, she may want to avoid these risks by having a VBAC.
Factors Contributing to a Successful VBAC
There are some factors that are related to having a successful VBAC, these include:
Maternal age less than 40 years. It has been shown in some studies that most women with successful VBAC attempts are less than 40 years.
Newborn weight less than 9 pounds. This is not always an indication for successful VBAC, but it has been shown that larger infant size have a higher uterine rupture rate.
At least two years since a prior delivery. It has been shown that the optimum time between inter-delivery births is 2-4 years.
Normal BMI. There is a higher risk of complications such as postpartum hemorrhage in women with higher BMI rates.
One or two prior c-sections. You are likely not a candidate for VBAC if you have had multiple c-sections, or if you have had a high vertical uterine incision.
Spontaneous labor. Inducing labor during a VBAC may increase the chance of labor ending in a C-section. Medicine used to induce labor can increase the risk of a uterine rupture.
Risk Factors involved with a VBAC
While a large percent of VBAC attempts are successful, there are still many risks involved:
Failed labor. The most common complication experienced during an attempted VBAC is failed labor. When this happens, women face a C-section after a long and difficult labor, which makes the surgery riskier than a scheduled C-section would be. This happens in roughly 20–40 percent of all VBAC attempts.
Uterine rupture. The most concerning risk is that of uterine rupture, a very dangerous and possibly fatal complication of a VBAC, which could lead to uncontrolled bleeding, infection, hysterectomy, and brain damage to the baby. A tear in the uterus can occur along a previous C-section incision scar.
Bleeding risks. Even in cases where the uterus does not actually rupture, the incision site from the C-section could bleed, causing the mother to experience dangerous blood loss and require transfusions.
OASIS. Higher risk of obstetric anal sphincter injuries (OASIS), which are also known as 3rd and 4th degree tears. Having a prior emergency c-section doubles the risk of an anal sphincter injury.
Ultimately it is a decision to be made between the health care provider and the patient. According to a recent study, “The success rate of VBAC as a safe and feasible method of delivery after a CS is high, especially when the inter-delivery interval ranges from 2 to 4 years” (Asgarian et al, 2019).
If you suffer complications due to a VBAC, you may have a case against the doctor, medical team, or hospital. Call our attorneys now to discuss your case in a free consultation.