Q & A: Is Vaginal Birth After Cesarean Safe?

Pregnancy bump vaginal birth after cesarean VBAC

Q: My first baby was born via cesarean. I’m expecting again and my provider said it’s just easier for everyone if I just schedule a repeat cesarean, but I would prefer a vaginal birth. Is VBAC safe? How do I prepare?

A: Vaginal Birth After Cesarean (VBAC) is a good option for most people who have previously given birth via cesarean surgery – there are a few factors that may make VBAC a less safe choice for an individual:

having a classical or inverted T uterine scar
history of surgery entering the uterine cavity
prior uterine rupture

As always, it is important to evaluate your individual case with your care provider – being sure to ask for and seek out related current research evidence behind any recommendations.

Choosing between VBAC and a repeat cesarean is such a personal choice, and you deserve to have complete, unbiased information on both options, including the risks and benefits of both. For example, often care providers cite uterine rupture as the major risk associated with VBAC, but it is important to note that this risk is fairly low at 0.87%. Unfortunately, care providers don’t always communicate the risks of repeat cesarean as part of the discussion, including that with repeat cesarean 1 in 22 women experience major complications, a hysterectomy rate that is about twice as high for a repeat cesarean as it is for VBAC, and the repeat cesarean risk of placenta accreta which is a life-threatening obstetric condition. Many of these risks continue to increase as the number of cesarean births increase.

Research shows that 2 in 3 women who pursue VBAC do go on the give birth vaginally, and there are certainly things you can do to increase the likelihood of vaginal birth:

Find a Care Provider who is Truly VBAC Supportive. There are providers in our area who are truly supportive of VBAC, but you may have to do some searching to find one. In our birth classes, we discuss questions to ask to determine a good fit with your care provider, as well as discussing the various care provider options in our area – including feedback from families who have pursued VBAC in the past.
Take an Independent Birth Class. Taking a birth class that is independent of your chosen birth place will give you quality information focused on evidence-based, family-centered care rather than through the lens of policies, procedures, preferences, and routines of the birth place. This approach will allow you the information and tools you need for truly informed decision-making related to your birth.
Practice Prenatal Yoga. A 2018 study in the Journal of Alternative and Complementary Medicine found that the need for induction of labor, pain medication, and cesarean surgery was lower in women who practiced prenatal yoga. Women who practiced prenatal yoga had significantly more normal vaginal births and shorter, more comfortable labors, as well as greater comfort postpartum. Our integrated prenatal yoga classes are empowering - offering mental and emotional preparation for birth, which is another important part of preparing for VBAC.

For most people, Vaginal Birth After Cesarean (VBAC) is a safe option. I encourage you to seek out good, quality information and support as you make the decision that is right for you.

Wonderfully Made Birth Services offers birth classes, private birth planning consultations, and prenatal yoga to help families recognize and connect with evidence-based care, discover their birthing options, learn specific techniques for a more comfortable and efficient birth, and become empowered to advocate for themselves and their babies. Please reach out – we’d love to help you prepare for your birth!

References:

International Cesarean Awareness Network. FAQs about VBAC. ICAN. Retrieved April 11, 2021, from ican-online.org/faqs-about-vbac/.

Dekker, R. (Host). (2020, January 28). The Evidence on VBAC (No. 113) [Audio podcast episode]. In Evidence Based Birth Podcast. Production Company. https://evidencebasedbirth.com/ebb-113-the-evidence-on-vbac/

Bolanthakodi C, Raghunandan C, Saili A, Mondal S, Saxena P. Prenatal Yoga: Effects on Alleviation of Labor Pain and Birth Outcomes. J Altern Complement Med. 2018;24(12):1181‐1188. doi:10.1089/acm.2018.0079

International Cesarean Awareness Network. Cesarean Awareness Month. ICAN. Retrieved April 9, 2021, from https://www.ican-online.org/cesarean-awareness-month-toolkit/#tab-calltoaction.

Silver, R.M, & Landon, M.B, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstetrics & Gynecology. 2006; 107:1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveries. Obstetrics & Gynecology. 2006; 108: 21-6.