For many women, vaginal birth after caesarean – VBAC – is a safe and positive way to have a baby. If you’re thinking about a VBAC, it helps to know about the possible benefits and problems.
What is a VBAC?
Women who’ve had a caesarean birth are usually physically able to try a vaginal birth next time around. This is commonly called a vaginal birth after caesarean or VBAC.
A VBAC is pretty much the same as any other vaginal birth, with one big exception. When you go into labour, midwives and doctors will monitor you very closely – more closely than if you hadn’t had a previous caesarean.
They might use special equipment to keep checking on your health and your baby’s health. This is so they can pick up quickly on any problems.
If everything is fine medically, you should be able to labour and give birth vaginally. But if there are medical reasons for not trying a VBAC, your doctor will recommend a planned caesarean. Reasons include placenta praevia
or high blood pressure.
Thinking about a VBAC
If you want to try a VBAC, it’s a good idea to choose a doctor or midwife who’ll support your choice. And it’s OK if it takes a while to find the health professionals who are right for you.
Your choice of hospital will also be important, because not all hospitals offer VBAC.
You can find out more about VBACs by going to birth classes. Some hospitals also have information about VBAC, so just ask what’s available. And talking with other women who have had a caesarean and are planning the birth of their next baby might help too.
I wasn’t fazed about the idea of having a vaginal birth after caesarean (VBAC). In fact, I was so looking forward to it that I didn’t let fear enter my mind! The hospital was very much in favour of vaginal birth, and there was no reason why I couldn’t try to have a VBAC.
– Louise, mother of two, one VBAC
Every woman’s experience of vaginal birth will be different and individual. But vaginal births – including VBACs – also have some common benefits for you and your baby.
For example, most women who have a vaginal birth will:
- recover more quickly from labour and birth
- have a shorter hospital stay
- be less likely to need to go back to hospital in the weeks after the birth
- have less need for strong pain relief after the birth
- be more likely to touch and cuddle their baby and have skin-to-skin contact straight after birth
- have a better chance of starting and continuing breastfeeding their baby
- be less likely to have complications in future pregnancy
- be more physically able to care for their baby (and their other children).
Many women say they feel well and happy after a vaginal birth. Women who experience vaginal birth often feel more satisfied with their whole birth experience.
Also, babies who are born vaginally are less likely to need time in the special care nursery for breathing difficulties. Some studies have shown that babies born vaginally tend to develop stronger immune systems and are less likely to have allergies than babies born by caesarean. This is thought to be because of hormones released during vaginal birth, and the important bacteria babies get through vaginal birth. They can usually have early cuddles and bonding too – good for your baby and good for you.
I now realise that there’s no ‘right’ way to give birth. My focus is on my beautiful children, not how they were born.
– Louise, mother of two, one VBAC
VBAC: possible disadvantages
If you have a VBAC, in labour your baby’s heartbeat will be monitored more closely. You might need to wear special equipment for this, which can sometimes make it harder to move around during labour. It can also make it difficult to use water for pain relief.
You also have slightly more risk of the scar in your uterus (as well as the one on your tummy) tearing or rupturing during labour. But it’s a very small risk to start with – it happens in only 1 out of 200 women having a VBAC. The risk of tearing increases slightly with each caesarean you have.
Tearing can happen with little warning, and it can seriously affect you and your baby. Often the tear can be repaired. In very rare cases, women need a hysterectomy (removal of the uterus) if they have severe bleeding and there’s a serious risk to their health.
The risk of tearing and its complications is why the doctors and midwives monitor you very closely during a VBAC.
VBACs do have a higher likelihood of unplanned (emergency) caesarean. This might happen if the monitoring shows that your baby is in distress or if your labour is very long, which puts more strain on your scar.
An unplanned caesarean can have more problems – such as infection and increased bleeding – than a planned (elective) caesarean.
If you’re thinking about a VBAC, it might help to know that your baby will be just as safe as if you were giving birth vaginally for the first time. You and your baby will be closely monitored by your doctors and midwives, and they’ll deal with any problems that might come up during labour.
Your chances of having a vaginal birth
Your chances of having a successful VBAC depend on a few things, including your health and the reason why you had a caesarean birth previously. If you’ve had a vaginal birth before, this improves your chances of a successful VBAC.
Having a comfortable and positive birth setting, caregivers and support people can increase your chances of having a vaginal birth.
Continuous support during labour – for example, from a familiar midwife, a close support person or a doula – might help you to feel more comfortable and relaxed.
Going to special VBAC classes is also a good idea, so you know what to expect.
Healthy eating and keeping active during pregnancy so that you’re fit and well can also boost your chances.
My doula was fantastic in reminding me of my rights and reinforcing them to my husband who could then talk with the staff. My husband demanded a doctor who would support my decision to try to VBA2C (vaginal birth after two caesareans).
– Noni*, mother of three, one VBAC
Birth centres, homebirth and VBAC
Talk with your doctor or midwife if you’re thinking about a VBAC and want to have your baby at a birth centre or at home.
Doctors and midwives will usually say that a hospital birthing suite is a safer choice. That’s because it’s better to be in a hospital in the unlikely situation of your scar tearing. Some hospitals offer midwife-led care for women who’d like to try for a VBAC.
It’s important to discuss your choices with your partner, midwife and doctor. If you’re still worried after this, you might want to get more than one medical opinion.
* Not her real name