Vaginal Birth After Cesarean

VBAC is an acronym which stands for vaginal birth after cesarean.  It refers to a woman who delivers a baby by cesarean section but then has a vaginal birth in a subsequent pregnancy.  It was once thought that if a woman had one cesarean delivery, all future babies needed to be born that way.  Today, however, women may be able to opt for a vaginal birth after cesarean (VBAC).  

Compared with cesarean section deliveries, vaginal deliveries (including VBAC) have the benefit of faster recoveries, shorter hospital stays, less complications in future pregnancies, less NICU admissions, decreased infection rates, and lower rates of hemorrhage.  Dr. Worley recognizes these benefits and proudly holds one of the lowest c-section rates in Central Florida and promotes vaginal deliveries and VBACs!

Not all women who have had a cesarean section can safely labor.  The providers at Alliance Obstetrics & Gynecology Group follow guidelines by the American College of Obstetricians & Gynecologists (ACOG) regarding who should and should not labor after a prior cesarean section.  In general, patients are not a VBAC candidate if they have any of the following:

• more than 2 prior cesarean sections
• any prior uterine surgery involving vertical incisions (typically performed for premature babies under 28 weeks delivered by cesarean section) or myomectomy surgery (remove uterine fibroids)
• a prior uterine rupture
• conceived within 12 months of the last cesarean section

The reason for your prior c-section may also influence whether a VBAC is recommended or contraindicated.  Dr. Worley and Dr. Silva will review your obstetrical history and work with you to determine the best and safest delivery method for you and your baby.

While VBACs are generally safer than repeat cesarean sections, they are not completely without risk.  The most significant risk associated with a VBAC is “uterine rupture”.  Occurring in less than 1% of laboring women with a prior cesarean section, a uterine rupture occurs when the prior scar opens up during labor.  It is an emergency and without prompt intervention, can lead to complications or even death to mother or baby if not quickly recognized and addressed.  This is most likely to occur in rural hospital settings without adequate staff support or experience.  Our providers have years of experience with VBACs and the hospitals with which we are affiliated are all staffed by a board certified OBGYN colleague 24 hours per day.  If needed, these colleagues are able to rapidly intervene and notify us should a complication arise.  

Most studies demonstrate a vaginal delivery rate of 60-80% in women attempting a VBAC.  The likelihood of success varies based on individual demographic and obstetric characteristics.  Women whose first cesarean section was performed because the cervix stopped dilating, or the baby never came down with pushing, are less likely to succeed in their attempt at a VBAC.  Those who have previously had a successful vaginal delivery or whose cesarean section was done for baby reasons (breech, heart rate problems during labor) are more likely to achieve a vaginal delivery.  The highest chance of success for a VBAC is in women who go into labor spontaneously before 40 weeks.  After 40 weeks of pregnancy, chances of a successful VBAC are low and increased risk of c-section occurs due to the baby being bigger and the placenta not working as well to support the baby’s oxygen requirements during labor.  For patients who are still pregnant at 40 weeks (or for women who need to be delivered prior to 40 weeks due to certain medical conditions or pregnancy complication), our physicians offer induction of labor as an alternative to repeat cesarean section.   

If you’ve had a c-section and desire a VBAC, set up a consultation with us at Alliance Obstetrics & Gynecology and The Center for Pediatric & Adolescent Gynecology.