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About a third of all babies in the U.S. are delivered by cesarean section. One factor influencing that statistic is that, in the past, when a woman had one cesarean birth, all future babies would also have to be born via C-section. However, obstetricians today are now encouraging women who meet specific criteria to try delivering vaginally for their next birth (known as VBAC or vaginal birth after C-section).
“One of the benefits is better bonding with the baby after birth,” says Ashley Hill, MD, medical director of obstetrics and gynecology at AdventHealth Medical Group. “You can have skin-to-skin time with the baby and breastfeed right away.”
Other Benefits of a Vaginal Delivery
In addition to bonding with the baby faster, moms who deliver vaginally also experience:
- Faster recovery, including being able to lift and care for older children more quickly
- Lower chance of blood clots forming in the legs and lungs
- Lower chance of wound or surgery complications
- Lower costs
- Shorter hospital stay
For babies, passing through the birth canal gives them extra immunities and helps clear their lungs as amniotic fluid is squeezed out during delivery.
Complications with Multiple C-Sections
“The more C-sections you have, the higher the chance it will be very difficult surgically to do the next C-section because of scar tissue formation,” Dr. Hill explains.“Patients with increased scar tissue formation are more apt to bleed a lot. You’ll also have a longer surgery and possibly more pain with recovery.”
Another serious complication we see in women who’ve had multiple C-sections is called “placenta accreta.” This happens when the placenta, which nourishes and supports the baby in the uterus, grows too deeply into the uterine wall. Scarring in the uterus from the C-section can lead to this condition.
Normally, when a baby is born, the placenta is also delivered through the birth canal. When it remains attached, women experience heavy bleeding, often requiring blood transfusions. It can also lead to an emergency hysterectomy.
“This can be an incredibly difficult situation,” Dr. Hill says. “If a physician isn’t used to handling complex cases, you can get into a lot of trouble quickly.”
Who Can Attempt a VBAC?
Between 60 and 80 percent of women who attempt a “trial of labor after cesarean delivery” (TOLAC)will achieve a vaginal birth. VBACs seem to be most successful when a mother’s had:
- A low transverse incision (most common type used for prior C-section)
- A prior successful vaginal delivery after a C-section
- No more than one to two previous C-sections
Some doctors use a VBAC calculator that looks at several factors to determine if a woman is a good candidate for a VBAC. These factors include your:
- Interval between pregnancies
When is a VBAC Not Recommended?
The type of incision used during the previous C-section plays a major role in whether a mom will be approved for a TOLAC. If the uterus was cut vertically, the odds are higher that it can rupture during labor, which can be life threatening to mother and baby. A uterine rupture may also require a hysterectomy. The risk of a uterine rupture occurs in less than one in 100 women who undergo a trial of labor, but the risk varies based on a woman’s prior obstetric history.
A woman’s scar on the outside doesn’t always match the scar on the uterus. “A doctor would look at medical records from the previous surgery to determine that,” Dr. Hill says. Because the chance of a successful VBAC goes down with certain situations, doctors may be more inclined to recommend another C-section when the:
- Baby is very large
- Mother is overweight
- Pregnancy has gone past 40 weeks
- Pregnancy is too close to the previous pregnancy/C-section (Ideal is 18 months between delivery of one baby and conception of another)
TOLAC should always take place at a hospital with a care level capable of handling any complications or performing an emergency cesarean delivery, instead of during a home birth.
Talk to Your Doctor and Be Flexible
All four of our Central Florida Baby Place locations offer the option of a VBAC to moms who meet the health criteria. “My advice to someone contemplating a VBAC is to find a group that’s willing to look at the pros and cons with you and have a long, informative discussion about it,” Dr. Hill said.
It’s important to keep in mind that even the best-laid plans may have to change. Women who attempt a VBAC will be closely monitored for any complications.
“Our top priority is for all women to have a healthy baby and healthy delivery, and when possible have a successful VBAC” Dr. Hill says. “Sometimes things happen with the pregnancy or the delivery that weren’t anticipated and throw a wrench into plans. In some cases, it might end up not being possible to have a VBAC, and that’s why having a trusting relationship with your doctor is so important.”