To VBAC or Not to VBAC?

1. VBAC is possible.

Not every woman with a previous cesarean is a good candidate for VBAC. Not every woman who tries to have a VBAC will have one. But many women are and do. In fact, 75% of the time VBAC is successful.

I had a VBAC in 2012. After my emergency cesarean in 2006, I was told in no uncertain terms that I should never try to have a vaginal birth or even consider going to full term in pregnancy. Yet, I did both of these things and lived to tell about it and I am not alone.

2. Education and facts matter.

There is a lot of misinformation that exists on the topic of VBAC. Most people still think: “Once a cesarean always a cesarean.” This is not true.

In this article ACOG says the following: “Most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about and offered TOLAC (trial of labor after cesarean)… After counseling, the ultimate decision to undergo TOLAC or a repeat cesarean delivery should be made by the patient in consultation with her obstetric care provider. The potential risks and benefits of both TOLAC and elective repeat cesarean delivery should be discussed.”

Additionally, an excellent resource for factual information is VBACFacts.com. Jennifer Kamel has spent thousands of hours researching and compiling the facts into an easily accessible and digestible format. She is not pro-VBAC or anti-cesarean. She shares evidence-based information through her website, classes and webinars.

3. There are risks for both VBAC and repeat cesarean.

VBAC risks will vary depending on many things including: health history, whether labor is spontaneous or induced, type of cesarean incision, etc.

When labor begins spontaneously after one bikini cut cesarean, the uterine rupture (UR) rate is 0.4%. It can increase with labor augmentation or induction. Out of that number only a small percentage result in tragic outcomes. Read this article to learn more.

Let’s put this in perspective. This rate of uterine rupture is similar to other obstetrical emergencies in first-time moms, including placental abruption and cord prolapse. Let me repeat this: placental abruption and cord prolapse can happen to any first-time mom at a similar rate that uterine rupture can happen to a VBAC mother. Did this consideration give you pause when having your first baby? Probably not.

We hear a lot of talk about the risks associated with VBAC. However, did you know that there are also risks associated with repeat cesarean? Some of the risks include: placenta accreta, placenta previa, surgical injuries, hysterectomy, blood transfusion and ICU admission. These risks increase with each subsequent surgery. In contrast, after a successful VBAC, the future risk of uterine rupture and other complications significantly decrease.

4. Your comfort and security is relevant.

Don’t let misrepresentation of the facts, social or family pressure sway you one way or the other. At the end of the day, you must be comfortable and feel safe and secure in whatever decision you make. Ultimately, you should do what is right for you in coordination with your care provider.

5. Make peace with either outcome.

Lastly, it’s a good idea to remain flexible while still aiming for whatever your preference is. A repeat cesarean can be an extremely healing birth when you choose it on your terms.

We don’t have 100% control in childbirth. Even if you choose to try for a VBAC, things may not go as planned on the big day. Knowing you were educated, prepared and advocated for yourself can help you to have a more satisfying experience no matter the outcome.