What is a vaginal birth after caesarean or VBAC?
Birthing mothers who’ve had one caesarean birth are usually able to safely try vaginal birth next time around. This is called vaginal birth after caesarean or VBAC.
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 midwife or doctor will recommend a caesarean birth.
What are the benefits of VBAC?
Vaginal birth experiences vary a lot among birthing mothers. But vaginal birth – including VBAC – also has some common benefits for birthing mothers and babies.
Birthing mothers
Most birthing mothers who have vaginal births will:
- recover more quickly from labour and birth
- be less likely to need to go back to hospital in the weeks after birth
- have less need for strong pain relief after birth
- have a better chance of having skin-to-skin contact and breastfeeding straight after birth
- be less likely to have complications in future pregnancies
- be more physically able to care for their baby (and their other children).
Babies
Babies who are born vaginally are less likely to need to go to a special care nursery or neonatal intensive care unit for breathing difficulties or other health concerns.
These babies tend to develop stronger immune systems and are less likely to have allergies than babies born by caesarean section. This is thought to be because of hormones released during vaginal birth and the important bacteria babies get through vaginal birth.
What are the risks and disadvantages of VBAC?
Women who’ve had a previous caesarean birth have an increased risk of complications with their next birth, but this risk is still low. You can read more about caesarean birth safety and risks.
Discomfort in labour
You might need to wear special equipment for monitoring your baby’s heartbeat and your labour contractions during labour. Sometimes the equipment can make it harder to move around during labour or to use water for pain relief.
Uterine tearing
Uterine tearing is when the scar in your uterus from your previous c-section tears or ruptures during labour.
This is one of the most significant risks of VBAC, but it’s a very small risk to start with. It happens in only 3 out of 500 birthing mothers having VBACs. This risk is even lower if you go into labour naturally and have at least 21 months between pregnancies.
The risk of tearing increases slightly with each caesarean you have.
Uterine tearing can happen with little warning, and it can seriously affect you and your baby. Often the tear can be repaired, but sometimes a hysterectomy is required.
Emergency caesarean
There’s a higher chance of an unplanned (emergency) caesarean birth with VBAC. 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 caesarean scar.
To minimise risks and ensure they’re ready to deal with any medical problems, midwives and doctors will monitor you and your baby very closely during a VBAC. This means that you and your baby will be as safe as you would be if you were giving birth vaginally for the first time.
How to increase your chances of having a VBAC
Your chances of having a 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 and you have a healthy, uncomplicated pregnancy, this improves your chances of having a VBAC.
Antenatal care
If you want to try a VBAC, it’s a good idea to choose a midwife or doctor who’ll support your choice. It’s OK if it takes a while to find the health professionals who are right for you.
Preparation
Knowing what to expect during a VBAC can help.
You can find out more about VBAC by asking your midwife or doctor and going to antenatal classes. Some hospitals have special VBAC classes. You might be able to do these classes online.
Talking with other birthing mothers who’ve had caesareans and are planning the births of their next babies might help too.
Healthy lifestyle
Healthy food, healthy weight gain and regular exercise during pregnancy can keep you fit and well. This boosts your chances of having a VBAC.
Continuous support during labour
This might help you to feel more comfortable and relaxed and increase your chances of having a VBAC.
This might be support from the midwife or small group of midwives that you’ve seen throughout pregnancy. This kind of support is called midwife-led continuity of care.
It might also be support from a close support person or a doula.
In general, a comfortable and positive birth setting, carers and support people can increase your chances of vaginal birth.
Where can you have a VBAC?
Not all birthing facilities offer VBAC.
Also, midwives and doctors will usually say that a hospital birthing suite is a safe choice. That’s because it’s better to be in a hospital in the unlikely situation of your caesarean scar tearing. Some hospitals offer midwife-led care for birthing mothers having VBACs.
Talk with your midwife or doctor if you’re thinking about VBAC and want to have your baby at a birth centre or have a homebirth.
It’s good to discuss your choices with your partner, if you have one, and your midwife or doctor. Sometimes it also helps to get more than one medical opinion.