Pregnancy Info

Vaginal birth after cesarean (VBAC) used to not be a child birth option. But, now more doctors are allowing women to consider having a vaginal birth even if they have had prior cesarean births. Keep reading to learn the protocols for VBAC as well as the pros and cons of VBAC.

What Is a VBAC?

VBAC is short for Vaginal Birth After Cesarean and pronounced /Vee-back/. It refers to delivery of a child through the birth canal after a birth in which the baby was removed through an incision in the mother's abdomen (sometimes referred to as a C-section), which may take place for a number of reasons.

The decision for a VBAC is made by a woman and her doctor, but not everyone should consider a VBAC. One factor that can rule out a VBAC is the incision used for the C-section.  Some surgical approaches to C-sections make VBACs too dangerous to contemplate.  The number of C-sections a woman has had is another key factor. Therefore, a woman's doctor needs to consult her medical records to ensure that a VBAC is safe for her to consider.

Protocol for a VBAC

When a VBAC is agreed upon, the initial period of labor is referred to as a "trial of labor" and is looked upon as a test for whether a vaginal delivery is safe.  During this trial period, the decision whether or not to go forward with an attempted vaginal delivery will be decided based on what actually happens.  Although the intention going into labor is to follow through to a vaginal delivery, the option may be taken to do a C-section if the trial indicates that it would be a better choice.

Because it is a "trial of labor" and a C-section is a known possibility, it is generally done with a surgical team and room available if needed.  In addition, the woman may be prepped by having an IV needle inserted or other procedures, so that the transition to the operating room is needed, it can be done as quick and seamlessly as possible.

Pros of VBACs

VBACs may be desirable for several reasons.  They are undeniably more natural.  If they are accomplished safely, the woman is spared from major abdominal surgery with a long recovery time compared to recovery from a regular birth, and more fully awake and aware and able to respond to and interact with her new baby. The mother has less pain, a shorter hospital stay, and a lower risk of infection.

Cons of VBACs

The greatest danger that a VBAC presents is the possibility of a uterine rupture.  The likelihood is less if the scar is low.  It is higher if labor is induced.

Current State of VBACs

In an article in Slate, David Dobbs reports that from 1994 to 2004 over 300 hospitals stopped the performance of VBACS.  The rate of VBACS has dropped from 27% in 1996 to 12.7% in 2002, and more since, with a rise in C-sections over the same period.  Dobbs claims that in its desire to reduce risk, the hospitals would rather not offer VBACs than take the chance of being sued, should something go wrong.

Sources

http://www.webmd.com/baby/guide/vaginal-birth-after-cesarean-vbac-overview

http://www.slate.com/id/2111499/