Vaginal Birth After Cesarean

Vaginal birth after Cesarean section (VBAC) is the term used to refer to deliveries that are performed vaginally after a woman has previously given birth via a Cesarean section (C-section).

Before the advent of the lower uterine segment C-section (LUSCS), most obstetricians advocated the principle of “once a Cesarean, always a Cesarean.” However, when the classic C-section was abandoned in favor of LUSCS, the possibility of women being able to give birth naturally after a pervious C-section gained attention.

For the classic C-section, a long mid-line incision is made in the abdomen and uterus, which increases the risk of rupture in any future pregnancies. The increasing pressure within the womb during labor can cause rupture of the scar tissue that forms after a Cesarean. This can lead to life threatening complications. Therefore, women who had already undergone one classic C-section, were usually recommended to have a C-section for any future deliveries, rather than a vaginal birth.

For the LUSCS procedure, a horizontal incision is made just above the pubic hair line and cuts through the skin as well as the underlying uterus. This horizontal surgical wound repairs and heals more easily than the vertical wound. After the LUSCS procedure, a woman is at much less risk of suffering a ruptured womb during future births and once this surgery was introduced, the incidence of VBAC rose dramatically after the 1970s and continued to rise well into the 1990s. After this period, the number of women opting for vaginal delivery after LUSCS started to fall due to fear of possible complications.

Today, while some obstetricians still recommend a C-section if there is a previous history of C-section, some advocate VBAC. The final decision is based on the obstetrician’s judgement and the mother’s preferences after her and her birth partner have been provided with the necessary information about the benefits and risks associated with VBAC.

Advantages of VBAC over repeat C-section

The recovery after vaginal birth is faster than after a C-section, requiring a shorter hospital stay. Babies born by VBAC are also less likely to have breathing difficulties around the time of birth than those born via C-section.

Risks associated with VBAC

Among women who undergo VBAC, there is still a risk that the C-section scar will open up. According to the modified guidelines by the American College of Obstetricians and Gynecologists (ACOG) in 2004, VBAC deliveries must always be conducted in a well equipped institution so as to ensure the availability of emergency care. After this warning was included in the guidelines, the VBAC rate fell by nearly half (from 24% to near 13% of all cases).