CWC - Vaginal Birth After Cesarean (VBAC)

Vaginal Birth After Cesarean (VBAC)
(Revised 7-15-01)

By: Bradley G. Goldberg, M.D.

Almost 25% of the babies born in this country are delivered by cesarean section. Of these cesarean
deliveries, one-third are repeat cesarean sections. In the past, it was believed that once a woman had a
cesarean section, that all of her subsequent deliveries should also be cesarean. However, the current
medical opinion is that if a woman understands the risks involved, a vaginal delivery can be attempted after a previous cesarean section. This is referred to as vaginal birth after cesarean, or "VBAC".

There are several reasons why a woman may want to attempt a vaginal delivery. First of all, there are
risks involved for the mother with a cesarean section, which is after all, major abdominal surgery. This includes the possibility for blood loss, transfusion, and infection although modern surgical technique can greatly reduce these risks.

There will be more days (usually 1 to 2) spent in the hospital after cesarean, and the overall recovery
time at home for the mother may be 2 to 4 weeks longer than the recovery from a vaginal delivery. In
addition, the hospital costs can be more than twice as expensive.

For all of these reasons, women who have had a cesarean in the past should be counseled regarding the possibility of natural delivery (VBAC)for subsequent pregnancies. Several studies support this
recommendation, and successful vaginal deliveries are possible in up to 80% of appropriately selected patients. The 20-30% who are not successful will require a repeat cesarean section.

As with most medical procedures, there are risks involved in attempting a vaginal birth after cesarean
section (VBAC). Although most women attempting this will do well, there is the potential for serious
complications. The most concerning complication is that of uterine rupture. This is when the scar on the uterus separates under the strain of contractions. Sometimes when this happens, it may be mild and not affect the baby. However other times it can be disastrous, causing permanent brain damage or even death of the baby.

I know this sounds scary, but in practice such a serious complication is rare happening less than 1% of attempted VBAC's. However, if it does happen, immediate surgery may be necessary. This is why it is important that women who chose to attempt VBAC do so in a hospital which has the capability of
performing an immediate emergency cesarean section if needed.

Please understand that I do not intend to discourage VBAC, but I do feel that any woman who chooses this option should be aware of the risks. If they are aware of these risks, and still chose to pursue a VBAC, then as stated above their chance of successful delivery is close to 80%.

An important point here is that some women may not be a candidate for a trial of labor after a previous cesarean delivery. For the most part, whether or not you would be a candidate depends upon the type of incision made on your uterus during the previous cesarean section, and upon how many previous cesarean sections have been performed. This information is readily available to your doctor through hospital records.

After obtaining these records, your doctor can discuss your options and any risks involved. Of course it is always your right as a patient to request the delivery route that you feel is most appropriate for you, and your baby.

Bibliography

1. Williams Obstetrics, 20th Edition, F. Gary Cunningham, M.D. et.al., Appleton & Lange, Stamford,
Connecticut, 1997.

2. Vaginal Birth After Cesarean Delivery, ACOG Patient Education, AP070, 1990, reviewed 1995.

3. Vaginal Delivery After Previous Cesarean Birth, ACOG Practice Patterns, No. 1, August 1995.