Your last delivery was a C-Section and you are pregnant again. Should you attempt a vaginal birth this time? The answer requires an in-depth look at what prompted the need for a C-Section in the first place, your personal wishes and how your pregnancy is progressing. Once all of the facts are known, making a birth plan that fits the physical and emotional needs of our Virginia Beach area patients is usually obvious.
Factors to consider
There are many factors that go into deciding whether it is safe to attempt a vaginal birth following a C-Section. These can include:
- Type of incision used
- Previous vaginal deliveries
- Circumstances surrounding prior C-Section
- Number of prior C-Sections – date of the most recent
- Facility that will be used for delivery
Deciding whether or not to attempt VBAC should be done early in your pregnancy. You can speak to your obstetrician as often as necessary to arrive at your decision.
Incision types
The greatest risk in attempting VBAC is rupture of the uterine scar during labor. This is very rare in women who have had the incision in the lower, or passive section of the uterus as described below.
Most cesarean incisions are low transverse; about 6” long across the lower area of the abdomen. In these cases the risk of rupture is minimal and if this is the type of incision you had, there is a 60 to 80% chance that you will be successful delivering vaginally.
Emergency C-Sections in pre term births sometimes require a vertical incision, called a classic C-Section. This incision is located in the mid section of the uterus which is very active during labor. It is not recommended that women who have had this type of incision attempt VBAC due to the risk of rupture. Also, if there is any history of a uterine scar rupture in the past, VBAC is not an option.
Prior C-Sections & Timing
If you have had several C-sections, or if your previous C-Section was less than 2 years ago, it isn’t recommended you attempt VBAC. Patients that are planning a larger family, who have had only one C-Section and are not already pregnant may want to space the next pregnancy beyond 24 months. This will provide the opportunity to attempt a VBAC for your next pregnancies.
Facility
Attempting VBAC must be done at a facility with 24-hour emergency capability should the need for an emergency C-Section arise. In Virgina Beach and other cities in Virginia, there are qualified medical facilities that are fully staffed at all times and these must be used by women with a history of C-Section.
Previous Vaginal Deliveries
Women with successful vaginal deliveries have a greater chance at success with VBAC since the reason for their more recent C-Section would not have been pelvic limitations. The reason could have been a breech birth, fetal stress or problems with the umbilical cord. If the incision used was a transverse incision, there is a good chance that a vaginal birth would follow the pattern or previous births.
Benefits of VBAC vs. C-Section
A vaginal birth requires much less recovery time than the six weeks that a C-Section requires. Care for the baby is easier after a vaginal birth and the risk of infection and other complications is greatly reduced. The risk of a failed delivery is centered upon rupture of the uterine scar and as mentioned previously, this is very rare occurring in about 1 out of 100 patients with a low transverse incision.
The benefits of scheduling a C-Section are that the procedure is scheduled, preventing an emergency situation. Also, there is no labor pain and less stress on the baby.
Is there any way to predict the success of VBAC?
As with all childbirth experiences, nothing is entirely predictable. Women considering VBAC will be sent for an ultrasound scan at about 37 weeks to see how big the baby is in relation to the size of the baby that required a C-Section. If this baby will be smaller or larger than the previous baby the decision may be easier to make.
At Virginia Beach OBGYN we understand the many factors that go into deciding whether or not VBAC is right. We serve Virginia Beach County and have several locations that can be easily accessed. Take advantage of the decades of experience we offer if you are wondering what to do now that you are pregnant after a C-Section. Our team is focused on ensuring a safe pregnancy and delivery for our mothers and babies, no matter what it takes.