Vaginal Birth After Cesarean Section

With the cesarean section rate approaching 33% in the United States (meaning that one out of every three women will undergo a cesarean section), interest is re surging in the VBAC (vaginal birth after cesarean section). The American Congress of Obstetricians and Gynecologists recently updated their guidelines encouraging women that are candidates for a trial of labor to consider VBAC. In the late 1970s through the 1980s, VBACs were very popular. Previously, the idea persisted that "once a cesarean section, always a cesarean" led practitioners to steer away from trials of labor and recommend repeat cesarean section. However, as more data accumulated regarding the success of VBAC, greater amounts of physicians began to offer this as an option to women.

As more women began to VBAC case reports of uterine rupture began to increase, which lead to a subsequent decrease in the rates of trials of labor after cesarean section and VBACs. Much of this decrease was driven by malpractice and litigation concerns. Admittedly, a patient hearing the words "uterine rupture" can be enough to make a woman jump on the OR table and offer to perform the c-section herself. However, before you decide that a VBAC isn't for you, there are several things you should know. First, while the risk of uterine rupture exists, the risk is only 0.5% of one previous cesarean section! Think of it like this. You have a 1 in 77 chance of dying in some sort of transportation incident in the next year, yet you still drive, take a bus, ride a train, or fly regularly done you? You have a 0.4% chance of dying from a fall in the shower, yet you shower (hopefully) daily. So yes, VBAC isn't risk free, but neither is a repeat cesarean section. Complications include bleeding, infection, injury to internal organs. Before jumping on the table, you might want to consider other options. Plus, your recovery is much faster after a vaginal delivery compared to a cesarean section. Finally, if you are planning on having a large family it behooves you to consider VBAC as the incidence of complications increases as the number of previous cesarean section increases.

Who are the ideal candidates? If you have had a previous vaginal delivery, a previous c-section for breech presentation or in an emergency, or a previous VBAC then you should ask your practitioner today!!! Regardless, you should consult with your OBGYN regarding if VBAC is right for you. Remember, PUSH! While labor is tough (after all it ain't called labor for nothing!), the benefits of VBAC are endless and should be considered!