VBAC is the phenomenon of undergoing a vaginal birth after previously delivering via caesarean. There are many reasons you might choose to switch back to a vaginal birth rather than undergoing a repeat caesarean section. Let’s explore what a VBAC involves, its risks, and benefits so when it’s time to deliver, you can make the best decision for you and your baby.
What Does a VBAC Involve?
A vaginal delivery requires a conversation with your doctor, so they understand your birth goals. It is important for you and your care provider to discuss the risks and benefits of a vaginal delivery after caesarean (VBAC). Some doctors and midwives may not feel comfortable offering VBACs, while other care providers may routinely perform VBACs.1
If you’re attempting to deliver vaginally after a previous caesarean, giving birth this time will involve a “trial of labour after caesarean,” or TOLAC. This literally means embarking on all the processes and steps of vaginal birth while being closely monitored for signs of distress. If you haven’t experienced labour, contractions, or vaginal delivery before, ask your doctor what to expect.2
About three out of four women who undergo a TOLAC will complete a vaginal delivery, and while the goal of a VBAC is to avoid a repeat caesarean, you and your baby’s health come first.3 Some women who attempt VBAC will be successful, while other women may need to switch course mid-labour to a C-section.4 This is a reason why Canadian healthcare agencies recommend attempting VBACs in a hospital setting rather than at home.2
What are the Risks of VBAC?
While VBAC is safe for most women, the risk of complications increases if:1,2,3,4,5,6
- You last delivered via C-section within 18 months
- You were last pregnant within 19 months
- You’ve had two or more C-sections for difficult labors in the past
- You achieved full dilation but then delivered via caesarean
- You are older than 35
- You have a high body mass index—over 30 mg/m2
- Your baby is considered very large
- You are over 40 weeks pregnant
- You have preeclampsia
- You use oxytocin to start or encourage labour
The biggest risk while attempting a VBAC is uterine rupture, a tear in the wall of the uterus. The tear often occurs at the site of the previous C section incision. This is rare but extremely serious. There is also an increased risk of infection should you end up switching to a C-section to deliver after a TOLAC. However, doctors will closely monitor you and your baby’s vital signs, such as heart rate, before, during, and after delivery to try to prevent complications. Both you and your doctor should be aware of any increase in vaginal bleeding after delivery, as it can be a sign of rupture.2
A VBAC should NOT be attempted if you have had previous uterine surgery, a previous uterine rupture or an “inverted T” scar from your prior caesarean, or certain placental conditions like placenta previa. Make sure to bring these up when you discuss your potential VBAC with your doctor.4
Rewards of VBAC
One of the most tangible rewards of a successful VBAC can be avoiding the recovery time after C-sections—and potential complications. This means you can return to everyday activities like walking sooner. It also means you may have a shorter hospital stay. But beyond that, VBAC can have several positive implications for a mother’s health, including:2,4
- Less pain after birth
- Reduced risk of post-partum fevers or infection
- Potentially less breastfeeding challenges7
When Should You Consider a VBAC?
Even if you have had more than one caesarean in the past or are carrying twins, a VBAC can still be an option for you. Some factors that lead to VBAC success include:
- Spontaneous labor not requiring induction of labour.
- Previous caesareans being based on a baby’s delivery position, such as breech or feet first, rather than stalled labor.8
- You’ve experienced successful vaginal delivery—even prior VBAC—before.1
A VBAC can be the most important decision a mother makes around her delivery, so if you’re considering making the switch with your next baby, talk to your doctor today to see if a VBAC can work for you.