Once a C-section always a C-section? Not necessarily so!
Among patients of reproductive age, there is a common misconception that if a woman has a cesarean section, all of her babies must be born the same way. However, clinical studies indicate that vaginal birth after cesarean section (VBAC) is a safe choice for the majority of women—including those with a previous C-section delivery.
To help me separate fact from fiction when it comes to VBACs, I contacted Erin Black, M.D., an obstetrician and gynecologist with Tennova Healthcare. Dr. Black delivers babies at Physicians Regional Medical Center in Knoxville.
Written by Ann Metz on behalf of Tennova Healthcare
KNOXVILLE MOM: Why do so many people assume VBAC is not an option?
BLACK: It is widely believed that VBAC is unsafe because of the chance of uterine rupture along the scar line. But in the vast majority of cases, this is not a concern. Toward the end of a woman’s pregnancy, the lower section of the uterus—where the cesarean incision is typically made—stretches out like a balloon and becomes nearly paper-thin. After delivery, the uterus contracts to its original shape. And within a few months, there is little if any evidence of weakness in the uterine wall.
According to the American Congress of Obstetricians and Gynecologists (ACOG), the risk of complications with a VBAC delivery is less than one percent, which is similar to the rate of other obstetric emergencies like a cord prolapse.
KNOXVILLE MOM: If the complication rates are so low, why don’t more women try to give birth vaginally with their next pregnancy?
BLACK: It’s true that most women who have had a previous C-section tend to schedule a C-section for subsequent births—despite the longer recovery time and higher risk of infection. The most recent information from the Centers for Disease Control and Prevention show that about 20 percent attempted VBAC, about 70 percent had a successful vaginal birth, and the other 30 percent needed a C-section anyway.
KNOXVILLE MOM: What do pregnant moms need to know about VBAC?
BLACK: Before deciding to pursue a VBAC delivery, it’s very important to know the risks and benefits. Researchers have found that women who have a vaginal birth after a previous cesarean delivery generally have fewer complications themselves, such as the need for blood transfusions or unplanned hysterectomies, compared with those who schedule a C-section. And babies born by C-section also have a higher risk for respiratory problems, even if they are born at term.
There are a few reasons why some women may not be able to give birth vaginally after a cesarean delivery. For instance, if they needed a C-section with their first child because the baby was too big to deliver vaginally and their next child is about the same size, they would not be a good candidate for VBAC. Twin gestation, a maternal age of 40 or older, and a history of uterine rupture or complicated uterine scars are other reasons your doctor might recommend scheduling a C-section instead of attempting VBAC.
You may be a good candidate for a VBAC delivery if your current pregnancy doesn’t have the same risks as a previous pregnancy. For example, if the first pregnancy involved a breech position, but the subsequent pregnancy is not, VBAC may be an option.
KNOXVILLE MOM: What if I end up needing a C-section anyway?
BLACK: Although about 70 percent of VBACs in the United States are successful, there are occasions when it just doesn’t work in a woman’s favor. If you wind up giving birth by C-section, don’t be discouraged. The goal should always be a healthy pregnancy and a safe delivery—for both you and your baby. That is the outcome we all want.
If you are considering vaginal birth after cesarean section delivery, talk to your doctor to find out if it is an option for you.
Need an OB/GYN? For a physician referral or to learn more about childbirth services at Tennova Healthcare, call 1-855-TENNOVA (836-6682) or visit Tennova.com.
This article in no way seeks to diagnose or treat illness or to serve as a substitute for professional medical care.