Vaginal birth after caesarean section (VBAC) is a safe option for many women who have previously given birth by caesarean section. In Forth Valley, all suitable women who have previously had a caesarean section are encouraged to consider vaginal delivery in a subsequent pregnancy.
Most women (3 out of 4) who have had one caesarean section, have a straightforward pregnancy, and go into labour themselves, successfully give birth vaginally.
Labour
While VBAC is recommended, additional care and monitoring are required in labour. VBAC should be undertaken in hospital with access to obstetric and anaesthetic help in case problems arise. It is recommended that your baby’s heartbeat is recorded continuously throughout labour with a CTG. You can still be active and mobile. Your midwife will discuss your birth plan with you during the antenatal period, advising on options for pain relief, including epidural if you wish.
Why Have a VBAC?
Having a vaginal birth after caesarean section has many advantages for you and your baby:
- No surgery required
- Quicker recovery time
- Lower chance of your baby experiencing breathing difficulties at birth
- Much lower chance of complications such as deep venous thrombosis (clots in legs or lungs)
- Greater chance of uncomplicated normal birth in future pregnancies
- Repeat caesarean sections increase the risk in subsequent pregnancies of stillbirth, miscarriage, placenta previa, and morbidly adherent placenta (placenta accreta/percreta)
Benefits for Your Baby
Attempting VBAC reduces the risk of your baby having breathing problems after birth. 3–4% of babies born by planned repeat caesarean section compared to 2–3% following VBAC. To reduce this problem, planned caesarean sections are delayed until after 39 weeks gestation. Risk of laceration (knife cut) is 2% for babies born by caesarean section; these are usually minor and heal well.
Risks with VBAC
Although VBAC is recommended, there are some risks:
- Chance of successful vaginal birth may be lower
- A further caesarean section may be required in labour
- Very rarely, the scar on the uterus may weaken and open (scar rupture), which can occur in up to 7 out of every 1000 women who plan VBAC
- With VBAC, there is a 1% higher chance of blood transfusion or infection in the uterus compared to planned caesarean delivery
- The risks to your baby (dying or serious complications within the first week of life) are similar in VBAC and women having their first baby (2 – 3 in 10,000)
Induction of Labour (IOL) and VBAC
Ideally, labour should start on its own for the highest chance of vaginal birth and fewest complications. You can safely wait until past your due date to give you the best chance of going into labour naturally. If induction is required, the safest option is using a “Cook’s balloon catheter”, placed through the neck of the womb to help stretch the cervix. You will receive full information if this is suggested, and any decision about induction will be fully discussed with your consultant obstetrician.
Your Care
Your team midwife and consultant obstetrician will discuss the risks and benefits, aiming to provide all the information you need to make a plan of care for your pregnancy and birth.