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person holding their stomach above a c-section scar and a baby in the other. Thinking about VBAC

What You Should Know about VBAC

If you’ve previously had a cesarean birth and are desiring a vaginal birth, there are many good reasons to consider attempting a Vaginal Birth After Cesarean (VBAC). Around 90% of women who have had one previous cesarean are candidates for a trial of labor after a cesarean, and up to 8 out of 10 women (80 percent) who attempt VBAC are successful in having their baby vaginally! The American Congress of Obstetricians and Gynecologists (ACOG) endorses that VBAC is a safe and appropriate choice for most women who have had a prior Cesarean.

Benefits and Risks of a VBAC

There are many individual reasons a woman may want to consider a VBAC. The most common one that I hear is that a woman wants to experience a vaginal birth. Other reasons may include that a woman desires an easier recovery, a shorter hospital stay, or lower pain than what is associated with a cesarean birth.

Women are often deterred from VBAC due to the risk of uterine rupture. Uterine rupture is considered rare, occurring in less than 1% of women with one prior cesarean, but it is serious when it occurs. The risks of a repeat cesarean are rarely discussed. It may surprise you to learn that some consider the overall risks of a repeat cesarean to be greater than those of a VBAC.

Risks of a Repeat C-Section

The main risks of a repeat cesarean are related to the fact that it is a surgery. A cesarean has more significant risks of bleeding, infection, or other injury to your body compared to a vaginal birth. Each repeat cesarean is more complicated than the last. The greater the number of cesareans you have, the greater the risk of developing complications in your future pregnancies like placenta accreta, which can be life-threatening to both a mother and her baby. Research hasn't established the exact number of repeat cesareans considered safe.

Due to the risks of repeated cesareans, one big question I ask women considering a repeat cesarean versus attempting a VBAC is, “How many children do you hope to have in the future?” If a woman desires 5 kids, for example, most obstetric providers (including myself) would encourage attempting a VBAC. If a woman wants only one more child, the surgical risks of a repeat cesarean may be less of a concern in a woman’s decision-making process.

Your Birth Plan Is Unique to You

This brings us to an important point: your decision regarding a VBAC vs a repeat cesarean should be individualized based on your own health profile and life goals. The decision to attempt a VBAC is an ongoing discussion between you and your OB provider throughout your pregnancy since things sometimes change and new risk factors can arise. In turn, if you’ve been planning a repeat cesarean and have changed your mind toward the end of your pregnancy and are now desiring a VBAC, by all means bring it up! VBACs, and all decisions in pregnancy, require open and honest discussions between a patient and provider. If your provider or hospital does not allow VBAC and you would like to attempt a VBAC, ask them to refer you to someone that provides this service.

How a Certified Nurse Midwife Can Help You Have a VBAC

Research suggests that women being cared for by certified nurse midwives have fewer cesareans and more VBACs. I like to think of midwives as experts in vaginal birth. In addition, midwives are able to spend more time prenatally focused on your individual goals for birth and helping you develop a plan to help achieve your goals. During labor, a certified nurse midwife can provide individualized support based on your goals, recommend positioning and strategies to encourage your labor progress, and offer a range of options for relaxation and pain management,

Certified nurse midwives work in close collaboration with obstetricians so that if the need for a cesarean arises, that option is immediately available. I also remind women that if you change your mind and end up desiring a repeat cesarean, you can still work with a certified nurse midwife and choose repeat cesarean at any time in your pregnancy.

Whether you choose a midwife or another obstetric provider, know that if you have had a prior cesarean birth, that VBAC may be an option for you. I recommend you continue to read about the option, and bring it up with your care provider if it interests you so that you can choose the safest and best option for your individual circumstances.

Reach out to your CHI Health Women's Health provider for more info.

Elizabeth Mollard, CNM
Elizabeth Mollard, CNM

Elizabeth Mollard, CNM, is a certified nurse midwife at the CHI Health Birth Center at Lincoln.

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