Is a Vaginal Birth After Cesarean Right for
You? Important Factors to Consider
Women who have had a cesarean section during
a previous delivery may question if they are
good candidates for a vaginal birth after cesarean
section (VBAC). Today many women can have vaginal
deliveries after a previous cesarean section
delivery. Both types of delivery have their risks
and benefits.
What is a Vaginal Birth After Cesarean?
A vaginal birth after cesarean section (VBAC)
occurs when a woman attempts a vaginal delivery
after a previous cesarean section delivery. Today,
many pregnant women are working with their healthcare
providers to determine if a VBAC is an appropriate
form of delivery for their individual situation.
Is a VBAC safe?
The safety or success of a VBAC is determined
by many factors such as a patient’s health
history, her current health, or the health of
the fetus. If a condition related to a previous
cesarean delivery does not appear in a present
pregnancy (i.e. a breech baby), then the patient
is a good candidate for a chance for a successful
vaginal delivery.
George
Macones, MD, MSCE, director of Maternal
Fetal Medicine at the University of Pennsylvania
Health System states, “The current guideline
provided by the American College of Obstetrics
and Gynecology (ACOG) is that for women who
had one prior cesarean section with a low transverse
segment incision (a horizontal uterus incision
typically in the area of the bikini line),
VBAC is a reasonable delivery option.”
What are the Benefits and Risks of a VBAC
Versus a Cesarean?
It is important to educate oneself on the
benefits and risks of a procedure when determining
the type of delivery you wish to undergo. Consider
the following when talking to your physician
or making your delivery decision.
Women who have a VBAC have fewer complications
and a faster recovery when compared to women
who have a repeat cesarean section. The most
important risk of VBAC is rupture of the scar
on the uterus during labor. This occurs in approximately
one in every 200 women who attempt a VBAC.
On the other hand, planning to have a repeat
cesarean section means that the date of your
delivery can be scheduled. In addition, rupture
of the scar on your uterus is unlikely to occur,
if you have a repeat cesarean section before
labor starts. Although a cesarean section is
a safe procedure, it is major surgery. Like any
other major surgery there are complications that
can occur, for example bleeding and infection.
How does an obstetrical provider determine
who is a candidate for a VBAC?
A practitioner will evaluate the patient’s
obstetrical history to assess their viability
for a safe VBAC. This will include an assessment
of the type of incision made during previous
cesareans.
A VBAC may or may not be an appropriate form
of delivery for you. Even a good VBAC candidate
may go through a trial of labor and ultimately
need a cesarean. 20 to 40 percent of attempted
VBAC’s result in a cesarean delivery.
Dr. Macones concludes, “The most important
aspect of VBAC is involving patients in the decision-making
process. We encourage our patients to read and
ask questions about VBAC.”
If you have had a previous cesarean section,
then it is important to learn more about your
options and to discuss them with your obstetrical
provider. Your obstetrical provider will assess
whether you are a reasonable candidate for a
VBAC and can review the pros and cons versus
an elective repeat cesarean section. This will
enable you to make a decision early in your pregnancy
and to have a plan for the birth of your baby.
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