Many women are disappointed when their birth doesn’t go as planned and they end up needing a Cesarean section instead of the vaginal birth they envisioned. A lot of women assume that because they have undergone one Cesarean section, that all of their subsequent births will need to also be Cesarean sections. However, this is not necessarily the case and a lot of women are able to have vaginal births following a Cesarean section.
If you would like to attempt a vaginal birth after having a Cesarean section, you will need to discuss this with your doctor. You will more than likely have what is called a ‘trial of labor after Cesarean (TOLAC)’. In this situation, you will go into labor with the goal to deliver vaginally; however, depending on how it goes, you still might end up undergoing a Cesarean section. In fact, around 4 out of 10 women who have a TOLAC will ultimately need to have a Cesarean section.
Is VBAC safe?
In general, VBACs are safe, although this can depend on a few factors such as how many previous Cesarean sections you have had and the reasons that you had a Cesarean section.
If you decide to undergo a TOLAC, you and your baby will be monitored closely and as with any labor, if the baby or mother shows signs of being distressed, a Cesarean will be performed.
The most serious risk of attempting a VBAC is that your scar from the previous Cesarean section could come open during labor and cause your uterus to rupture. This is very rare, but does pose a serious threat both to you and your baby. The type of uterine incision used in the previous Cesarean section has an effect on the risk of uterine rupture, with some types of incision being more likely to result in rupture than other types. The safest type of incision is a low transverse incision (side to side) – women who have had one or two Cesareans with this type of incision can undergo a TOLAC. In contrast, high vertical (up and down) incisions carry the highest risk of rupture and the American College of Obstetrics and Gynecology recommends that women with this type of incision do not undergo a TOLAC.
Due to the risk, albeit rare, of uterine rupture, VBAC should only be attempted in hospitals that can do a rapid emergency Cesarean section if this complication occurs, and should not be attempted in a birthing center or at home.
You also have an increased risk of infection if you undergo a TOLAC and end up needing a Cesarean section, compared with a planned Cesarean section or a vaginal birth.
What factors increase my chances of having a successful VBAC?
The likelihood of a successful VBAC is influenced by many factors, with the main ones being:
- You are younger than 35 years of age
- You do not have the same condition that led to the first Cesarean section (such as a breech baby)
- Your labor starts on its own without need for medication and you have a well dilated cervix
- Your previous Cesarean was not done for stalled labor
- You have already had a previous successful VBAC.