Highlighting Cesarean Awareness Month: Everything You Need to Know about VBAC

Each April, the medical community observes Cesarean Awareness Month to increase understanding and education about Cesarean sections (C-sections), including their associated risks and the conditions in which they become necessary.

C-sections are used in various situations during childbirth, primarily when vaginal delivery would put the baby or mother at risk. If there are signs that the baby is in fetal distress or if the labor is not progressing as it should, a C-section might be necessary. In addition, if the baby is not in a head-down position and efforts to turn the baby before delivery have not been successful, a C-section might be the safest option. Other factors indicating a C-section include multiple births, placental disorders like placenta previa or abruption, umbilical cord prolapse, certain maternal health conditions, and macrosomia, where the baby’s large size is a concern.

Risks of a C-Section

Like any surgical procedure, C-sections can carry risks for both mother and baby; mothers face higher risks of infection, hemorrhage, adverse reactions to anesthesia, blood clots, complications in future pregnancies, longer recovery times, and possible surgical injuries. Babies may experience breathing problems, rare surgical injuries, and delayed skin-to-skin contact affecting bonding and breastfeeding. Additionally, there can be emotional and psychological effects, particularly if the C-section was unplanned or varies from the expected birth plan.

Every expecting mother should discuss her individual situation with her health care provider to determine what delivery method is safest for both her and her baby, said Michelle Lende, DO, a Maternal-Fetal Medicine physician with CHRISTUS Children's. Often, the benefits of a C-section can outweigh the risks, particularly when recommended for medical reasons. But for many women, a safe option is a vaginal delivery—even if they’ve already had a previous C-section.

VBAC: A Safe Option for Many

Historically, women with a previous C-section typically underwent the same procedure for all future deliveries. However, over the past few decades, Vaginal Birth After Cesarean (VBAC) has emerged as a safe and viable option for many women, offering the possibility of vaginal delivery in some cases.

VBAC is recommended to many patients because it can offer several benefits compared to repeat C-sections, such as a shorter recovery period, lower risk of surgical complications, and reduced risks associated with multiple abdominal surgeries, said Dr. Lende. Still, it depends on the individual patient, their medical history, and factors associated with their current pregnancy.

Benefits of a VBAC

Benefits to a successful VBAC include a lower risk of complications such as infections, blood transfusions, blood clots, faster recovery compared to repeat C-sections, and reduced risks in future pregnancies. It can also lead to fewer surgical complications, a greater likelihood of future vaginal deliveries, and immediate contact with the baby, enhancing bonding and breastfeeding.

However, Dr. Lende noted, VBAC is not suitable for everyone. Certain factors, such as the type of incision made in the previous C-section, the reason for the previous C-section, the number of previous C-sections, and other individual health factors, can affect a woman's eligibility for VBAC.

A VBAC is generally safer for women who've had a low transverse (horizontal) uterine incision, as this type is less prone to rupture compared to a vertical incision, and who have had no other uterine surgeries and no major health, obstetrical, or fetal issues that would contraindicate the procedure, Dr. Lende said.

Success Rate

There are a variety of factors that can help predict a successful VBAC, but the overall success rate for VBAC can be as high as 60 to 80 percent for some women. However, there is always the possibility of needing an unplanned or emergency C-section after a VBAC is attempted.

The biggest risk associated with VBAC is the risk of uterine rupture, where the scar from the previous C-section could tear open during labor, Dr. Lende said. This is a serious complication and requires emergency surgical intervention. It can also lead to a higher risk of excessive bleeding after delivery as well as maternal and fetal harm.

In addition to discussing each option carefully with your OB-GYN, it is also important to consider the facility in which you plan to deliver, and whether it is equipped to handle any type of complication or emergency. According to the American College of Obstetricians and Gynecologists, VBAC should take place in a hospital or high-level medical facility that can manage situations that threaten the life of the woman or her baby.

The potential benefits for VBAC are numerous, Dr. Lende said. The decision to pursue a VBAC should be made after thorough consultation with your OB-GYN, where an assessment of the risks and benefits will be tailored based on your specific circumstances. For many patients, knowing that VBAC may be an option is empowering and can offer autonomy when it comes to making decisions surrounding delivery.

To learn more about the Women’s and Newborn Center at CHRISTUS Children’s.