Have you experienced a Caesarean section? Do you now find yourself wondering about the options for the birth of your next child? Vaginal birth after Caesarean section (VBAC) might be an option for you. But it’s important to understand the specific considerations and criteria to ensure a safe delivery.
In this article, we’ll answer your questions. We’ll also give you well-rounded information—so that you’re empowered to have an informed conversation with your practitioner on the best following steps for you and your baby. Please note that the following text explores possible options but doesn’t cover everything. Be sure to discuss your personal situation with your healthcare provider.
VBAC vs. TOLAC
You may come across two terms:
– TOLAC—Trial of Labour after Caesarean
– VBAC—Vaginal Birth after Caesarean
VBAC is used more commonly than TOLAC, but it essentially has similar meaning. TOLAC is a planned or attempted vaginal birth after Caesarean section. A birth is officially considered a VBAC once the TOLAC results into successful vaginal delivery. In the text below the term VBAC will be used to simplify your reading.
In general, VBAC is an alternative for mothers who have previously delivered via a Caesarean section and are desiring to have a natural delivery.
Reducing Caesarean deliveries has been a significant focus in the medical communities due to the benefits for both mother and baby. As a result, a VBAC is becoming more common for many women and their practitioners.
Success rate of VBAC
According to in-depth research, a VBAC delivery can be a safe choice for many women. It even boasts a success rate of 60–80%.
Several reasons could have led to the first Caesarean section. These include a breech position, medical complication for mother or baby, a prolonged labour or second stage of delivery.
Whatever the cause, a VBAC may be an option for the next birth.
Why is the VBAC demand rising?
In the past years, more and more women have been opting for a VBAC. There are many reasons, such as no need for another abdominal surgery, faster recovery time, quicker return to normal activities, lower risk of infection and less blood loss.
On top of that, some women would simply prefer to experience vaginal childbirth. Also, preventing another caesarean may be especially desired for a woman planning to have several future pregnancies, as it can reduce the risks associated with multiple caesarean deliveries—like placental issues.
Possible challenges of a VBAC
VBAC can be a fulfilling option. But still, there are potential challenges. It is key to have a thorough conversation with your physician to make the best-informed decision for you.
The most concerning complication is a uterine rupture. Although very rare, less than 1%, it can be quite serious. This occurs when the previous incision of the uterus opens during labour. That can then cause significant harm to both you and your foetus. If you are at high risk for uterine rupture, a VBAC should not be attempted.
You and your physician may consider numerous factors when deciding whether it is for you.
Can I get a VBAC?
Together with your physician, you might need to discuss:
- Your full medical history
- Details of prior births (including both vaginal and caesarean deliveries)
- Labour progress
- Reasons for previous Caesarean
- Type of uterus incision
- Current complicating factors (breech baby, placental complications, number of currently carried babies etc.)
Here are some things to consider in more detail:
- Have you had other uterine surgeries, such as additional caesarean deliveries or fibroid removal?
- Has it been less than 18 months since your previous delivery?
- Are there any reasons specific to this pregnancy that otherwise result in a Caesarean (for example, abnormal placenta placement, abnormal baby position, expectation of multiples…)?
If you’ve answered ’no’ to all of the three above, then it may be likely that you can continue with a VBAC. There are some factors that increase the probability of a successful VBAC, such as a previous vaginal delivery and spontaneous labour. But these are not required.
One more thing to consider is the type of the uterine incision used in your previous Caesarean.
Previous uterine incision
Most C-sections are done with a low transverse (horizontal) incision. If you have this type of Caesarean section scar, you might be eligible for a VBAC.
But occasionally, the incision on the uterus is vertical. This can be referred to as a classical incision. In this case, a VBAC is not recommended due to the risk of complications.
Please note: The skin incision is not important in this case. What matters is where the uterine incision was made. In some cases, a mother may have had a low vertical incision on the skin but a classical incision on the uterus. It is required to have medical records of the type of uterine surgery that was performed.
VBAC and labour induction
About 30% of all expectant mothers require an induction of labour. The good news is that if you are eligible for a VBAC, an induction is a viable option.
As with any induction of labour, cervical ripening is crucial to success. When planning for an induction of labour, your physician will evaluate your cervix using a Bishop’s Score. This score provides information into how ready your cervix is to be induced. The higher the score, the more „ripened“ the cervix is. For scores <6, cervical ripening is the recommended first step.
Generally, there are two common methods for labour induction—pharmacological and mechanical. Mechanical options such as DILAPAN-S do not contain any drugs and as a result, they seems to be more suitable for mothers looking for a VBAC delivery.
If you would like to learn more about the IOL with DILAPAN-S, visit our website.
Making an educated choice
VBAC can be a viable and safe option for many women. With a success rate of 60–80% and numerous health benefits, including faster recovery, lower risk of infection and more, it is an enticing alternative to repeated surgeries.
At the same time, the safety of you and your baby is the number one priority. It is important to consider your full medical history, the type of the previous uterine incision and potential issues, especially the rare but serious uterine rupture.
By understanding all factors and discussing them with your physician, you can make a confident decision for you and your baby.
Monica Myron
-certified registred nurse
