The VBAC has become a hot topic. It’s kind of a beast of an issue so I’ve been putting off this post for a while because it’s hard to even decide where to start but here it goes!
As most woman who have had a cesarean can attest, recovery from abdominal surgery is not the easiest or most fun thing to do, especially when you have a newborn to care for. The benefits of a successful VBAC should be quite obvious, but just in case it’s not let’s quickly point out some of the cons of a cesarean: Much slower recovery, more difficulty establishing breastfeeding, longer hospital stay, more expensive, less release of important bonding hormones, high frequency of breathing problems in cesarean babies, small chance of cutting mothers organs or the baby, painful incision for weeks, and reduced fertility just to name a few!
The largest fear of most physicians in a trial of labor after cesarean (TOLAC) is that the scar tissue from the previous cesarean will separate or open. This is referred to as uterine rupture. The chance of uterine rupture in a TOLAC is 325/100,000. That is about one third of one percent. In the case of a planned repeat cesarean there is still a chance of uterine rupture (26/100,000). Even though rupture is more common with a TOLAC maternal death rate is actually lower for woman attempting a VBAC than it is for woman having a repeat cesarean. It should also be noted that the majority of babies are fine at birth even after a rupture.
Most woman who plan a TOLAC will have a vaginal birth. Your chances of success increase when you hire the right care provider. Look for a care provider who attempts VBACs often and has at least a 70% success rate. You may need to interview several people. It is beneficial to have a doula with you who has assisted with a VBAC birth before (such as myself *wink wink*.) It is also important to avoid pharmacological induction whenever possible as these artificially increase the intensity of your uterine contractions and increase your risk of rupture.
If you decide that a TOLAC is right for you, you may be surprised to find that there are some hurdles to get over before you can move forward. For many reasons (fear of litigation, malpractice insurance costs to name a few,) about 50% of physicians do not offer VBAC as an option. There can also be hurdles involving which hospitals you can labor at. If a VBAC is what you want, make it happen!
My personal opinion is that while repeat cesareans are at times necessary, a VBAC is worth attempting and even fighting for. There are so many benefits for mom and baby alike in vaginal birth!
The information in this blog came from Pregnancy Childbirth and the Newborn 4th edition (Chapter 14)
If you’d like to learn more on this topic I’d recommend http://www.VBAC.com
Please feel free to ask me directly if you have a specific question on this topic. I hope this added some clarity to vast amounts of information that is available out there on VBACs.