VBAC

What is VBAC?

VBAC (pronounced veeback) stands for vaginal birth after caesarean section. It's the term used when you give birth vaginally, having had at least one baby born by caesarean section.

How does a VBAC differ from normal childbirth?

The main difference is how often and how closely your labour will be checked. You'll be offered continuous electronic fetal monitoring. This is to allow your baby's heart rate and your contractions to be measured at all times.

Many women have a successful VBAC without any complications at all. But there is a very small risk that the scar from your previous caesarean could tear. This is called uterine rupture.

Rupture affects only one in 200 women trying for a VBAC. Although the risk is small, your medical team will want to watch out for it. If your baby's heart rate doesn't sound right, it could be an early sign that there is a problem with your scar.

During a VBAC you can have an epidural for pain relief if you want one. Some hospitals may support you using a birth pool to help you cope with your contractions.

This will depend on why you had a caesarean last time. Your doctor will want to know how your last pregancies went, because if you use a pool your baby can't be monitored all the time.

What's the alternative to a VBAC?

The other option when you've had a caesarean is to have a planned repeat caesarean. This is usually booked for the seven days leading up to your due date, unless your baby needs to be born sooner for a medical reason. Overall, repeat caesareans and VBAC are both safe ways for you to have your baby.

You'll have plenty of time to mull over the risks and benefits of both options. Talk to your obstetrician about your previous birth or births. This will help you come to a decision about how to have your baby this time around. You'll be encouraged to decide by the time you are 36 weeks pregnant.

What are the advantages of a VBAC?

The main advantage is that you have a vaginal birth and avoid the risks of caesarean birth. You'll have much less pain after the birth and a shorter stay in hospital.

Your baby is also slightly less likely to have trouble breathing after he's born, although few babies have this problem. If you felt disappointed that your last baby was born by caesarean, you may have a sense of achievement if you have your next baby vaginally. And once you've had one successful VBAC, you're more likely to have another one.

What are the disadvantages of a VBAC?

The disadvantages of VBAC are generally the same as with any vaginal birth. In the short term, these can include:

• Pain from bruising and stitches in the area between your vagina and back passage (perineum).
• Urine leaks, while the area round your vagina recovers.

In the long term, vaginal birth may slightly increase the risk of your uterus slipping into your vagina (prolapse). But other factors also contribute to prolapse in later years. These factors include:

• the type of vaginal birth or births you've had
• the number of babies you've had
• whether your mum or sister had prolapse
• whether you are overweight
• whether you are often constipated

Pregnancy itself can weaken your pelvic floor. This can lead to problems such as incontinence in later life. So you still need to do your pelvic floor exercises!

Trying for a VBAC, instead of choosing a caesarean, carries a slightly higher risk that something may go wrong. The chances of this happening, though, are very small. They include:

• needing a blood transfusion
• infection in your uterus after the birth
• in rare cases, rupture of the uterus

What else do I need to be aware of?

All labours are unpredictable. So there's always the chance that you might have to give up on your VBAC. A quarter of women who try for a vaginal birth then need an emergency caesarean. This usually happens because labour has slowed right down, or there are worries about the baby's wellbeing.

But bear in mind that a woman trying for a VBAC is only slightly more likely to need a caesarean than a first-time mum in labour.

Take time to explore your feelings about the birth. Do you feel that you cannot face a failed VBAC attempt? Or do you feel that you should at least give it a go? It's a highly individual decision. It can be difficult to decide, so talk it over with your midwife and doctor and your loved ones.

What are my chances of achieving a VBAC?

Your chances of having your baby vaginally are likely to be good. But it does depend on why you needed a caesarean before. It also depends on how your pregnancy is going this time around.

If you needed a caesarean for a reason that won't change, such as a small pelvis, then you may need to have a caesarean again. However, if you had a caesarean because of something unique to your last pregnancy, such as a breech baby or a low-lying placenta, you stand a good chance of having a VBAC.

It may help you to look at the numbers. Your chance of a successful VBAC is:

• Between 87 per cent and 90 per cent if you've given birth to at least one baby vaginally in the past, particularly if it was a VBAC.


• Between 72 per cent and 76 per cent if you've had one previous caesarean.


• Between 70 per cent and 75 per cent if you've had two previous caesareans. This is very similar to the rates for vaginal birth for first-time mums. Read what our expert has to say about having a VBAC after several caesareans.

VBAC success rates are lower if you:

• Have your labour induced, particularly with prostaglandins. These are hormone-like substances that help stimulate contractions. Induction puts a greater strain on your scar and makes uterine rupture two to three times more likely than if you went into labour naturally.


• Have only ever given birth by caesarean.


• Previously had a caesarean because your baby got stuck during labour.


• Are obese, with a pre-pregnancy body mass index of more than 30.

If all four of these factors apply to you then your chance of achieving a VBAC is reduced to 40 per cent. A repeat caesarean may also be safer than a VBAC if you are expecting a big baby.

Can I have a VBAC at home?

A home birth is always an option if you are hoping to have a vaginal birth. However, you may find that your doctor and midwife are less keen to support you trying for a VBAC at home. This is mainly because of the small risk of uterine rupture.

Having a VBAC at hospital means that if the worst happened, for example if your scar tears, you can be treated straight away. Ideally, a caesarean should be done within 30 minutes of an emergency arising. You could find out what the transfer time into hospital from your home would be to help you decide.

If you want to have your baby at home it may be worth getting in touch with one of your local heads of midwifery. Your midwife can give you their names. A senior midwife can take you through all your options. She can also help you to plan the safest care for you and your baby.

You could also employ an independent midwife, but you will have to pay for her services. Contact the Independent Midwives Association for a list of midwives in your area.

Key messages

Whether or not to have a VBAC can be a difficult decision. So here are the key points again:

• If you wish to have a VBAC, your doctor should support your choice. However, you should also be fully informed about the pros and cons.


• VBAC carries a small risk of uterine rupture.


• If your doctor or midwife is unsupportive of your VBAC, contact your local head of midwifery to discuss your case, or consider using an independent midwife