One of the murkiest childbirth topics I’ve come across is how to attempt a vaginal delivery after a Cesarean section (VBAC).
Schools of thought cover each end of the spectrum from, “Once a cesarean, always a cesarean,” and “Don’t listen to naysayers because your body knows best." I’ve also encountered personal anecdotes from every side, including the woman who delivered vaginally in an unassisted home birth and the one whose uterus ruptured in a monitored hospital birth. All the information out there makes decision-making a constant game of second-guessing yourself.
There’s no one straight path toward a successful VBAC, but there are plenty of factors to help determine if it’s a route you want to consider. The lessons below are what I’ve culled from my own journey toward a (hopeful) VBAC with an obstetrician in a hospital setting. In no circumstances should they replace a professional consultation based on your own personal medical history.
It’s frustrating each and every time to have to explain why I don’t just “go for the C-section” when there is no concrete answer.
Why do you even want a VBAC?
This is the question I’ve heard the most often, from distant medical professionals to the people closest to me in life. It’s frustrating each and every time to have to explain why I don’t just “go for the C-section” when there is no concrete answer.
That said, my C-section baby is now a happy, healthy and intelligent kid and the way he was delivered seems to have had no long-term effects physically or emotionally. But recovering from major surgery is brutal. The idea of doing it again while managing a newborn and a kindergartner is daunting.
Obviously, I know that a vaginal delivery is a whole lot of not fun and I have the same profound fears of childbirth as most women, i.e. the pain of labor, possibility of tearing, pooping on the table in front of my husband.
But having been through a C-section already, the answer is simple: My gut is telling me to try for a vaginal birth. That’s the best explanation I can come up with for anyone who asks.
Why are VBACs so controversial?
Many OBs and even entire hospitals refuse to do VBACs altogether, mostly for liability reasons. For women who delivered via C-section in a previous birth, there is an elevated risk of uterine rupture—when the uterus tears at the site of the original scar. It’s a rare occurrence, less than 1 percent, but a catastrophic rupture can put the lives of both mother and baby at risk.
Am I a good candidate for a VBAC?
A huge array of factors can result in a failed trial of labor after a Cesarean delivery (TOLAC) including: multiple previous C-sections; a vertical (classical) incision versus the more common low transverse incision; and if it’s been less than 18 months from your last C-section.
Other issues can arise during your pregnancy, like preeclampsia or a high birth weight. An OB may push for a C-section if you don’t spontaneously go into labor at 40 weeks—although a longer gestation period isn’t statistically riskier, some doctors aren’t keen on using induction methods like Pitocin or a Foley bulb to jump-start labor for fear of the uterus rupturing.
Again, you can always find anecdotal evidence of women who had successful VBACs in all sorts of circumstances, but expect your OB or midwife bring up these types of issues.
Is my OB on board with a VBAC?
VBAC Facts has a comprehensive list of questions to ask your provider to determine if they’re “VBAC-friendly.” Among the most important are what percentage of their births have been successful VBACs and how many uterine ruptures they've witnessed.
However, you may find some topics simply don’t apply to you. Personally, several factors that might lead my OB to insist on a C-section would also be deal-breakers for me, like multiples or breech position. Still, take the time to go through each question carefully with your health-care provider so you can make an informed decision.
While over-Googling has led me down many virtual rabbit holes, I’ve found the only way to feel comfortable with my decision is to research as much as possible, listen to different perspectives and ultimately know that delivering a healthy baby is my No. 1 goal.
Below are some helpful resources to get started:
The American Congress of Obstetricians and Gynocologiest (ACOG) stance on VBACs