Moms-to-be: Where and When Can You Have a VBAC?

It is not uncommon for women who have had one or more cesarean sections to want to give birth to their next child vaginally. This practice is known as vaginal birth after cesarean (VBAC). Many assume that once you have a c-section, you always have to have a c-section, but this is not necessarily true. In some cases, c-sections can be medically necessary, sometimes even life-saving. However, the rise of the c-section rate for non-medically necessary reasons is on the rise, and is a concern, according to a recent study published in The Lancet.

All women who have experienced cesarean birth have the right to safe and accessible options when giving birth in subsequent pregnancies. This is the position statement of American College of Nurse Midwives (ACNM) for VBAC.

Benefits of a successful VBAC include less blood loss, lower risk of infection, no abdominal surgery and a shorter recovery period, says the American College of Obstetricians and Gynecologists (ACOG). VBACS can prevent health problems linked to multiple c-sections such as bowel or bladder injury, hysterectomy and problems with the placenta in future pregnancies. ACOG describes what is called a TOLAC – trial of labor after cesarean delivery. If it is successful, TOLAC results in a vaginal birth. If it is not successful, you will need another cesarean delivery.

Of course, VBACs do come with risks, as ACOG points out. These include complications such as blood loss or infection. A rare, but serious risk is a rupture of the uterus, which can occur if the cesarean scar breaks open. Some uterine scars are more likely than others to cause a rupture. Medical records from your previous delivery will show what type of uterine incision you had. Make sure that you show these records to your OB/GYN or midwife so that they can review them closely.

Last year, PBS wrote a piece that talked about an expecting mother, Alicia Skrenes, who had had two c-sections and wanted a vaginal birth for her third child. Skrenes had had a hard time finding a hospital in her area that would accept her birth plan – a VBAC. After months of research, she did find a fully VBAC supportive doctor. This is a problem not uncommon across the country.

Burdett Birth Center offers VBACs. Our successful VBAC rate for 2018 was 72.5 percent, while our cohort was 65.5 percent. (A cohort group is hospitals that average close to the same number of deliveries Burdett averages.) In addition, our c-section rate was 23.7 percent for 2018, compared to 29.5 percent for our cohort. Our primary c-section rate at 11.9 percent and our repeat c-section rate was 11.9 percent, compared to 16 percent and 13.5 percent for our cohort. (More information can be found on the New York State Department of Health (DOH) website.)

If you have any further questions about vaginal birth after c-section (VBAC), we recommend that you talk with your healthcare provider.

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