If the first delivery is cesarean, can the second be normal? Women who’ve had a previous C-section are usually encouraged to skip VBAC and schedule cesarean delivery for subsequent births. However, each pregnancy is different. Just because one of your pregnancies required having a C-section, that doesn’t mean the next one will.

This article shall address what VBAC means, why VBAC, the pros and cons of VBAC, how to increase chances of VBAC, and the recommended guidelines.

What is VBAC?

A VBAC is a vaginal birth after cesarean. It is one of the birthing choices available to women even after having one or two C-sections. Many people are unaware that it’s an option, and it’s not talked about as often as it should be. There seems to be this old motto of “Once a C-section, always a C-section,” but the reality couldn’t be further from the truth.

Is VBAC worth it? A repeat C-section significantly increases the risk of complications such as injury to adjacent organs, infections, abnormal implantation of the placenta, and placenta previa where the placenta covers the cervix. If you plan to have a large family, you may wish to consider a VBAC.

Who is a good candidate for VBAC?

Anyone who has had no more than two prior cesarean sections is a candidate for VBAC. Almost 90% of women who have undergone a cesarean delivery are viable VBAC candidates. According to the American Congress of Obstetricians and Gynecologists (ACOG), having a VBAC is safer than a repeat C-section, with 60-80% success rates.

The VBAC facts notwithstanding, plenty of care providers and hospitals are not equipped to do a VBAC, and some refuse to do them. Any ob-gyn or hospital supporting VBAC chooses to do so voluntarily.

The other criteria that can make you a better-suited VBAC candidate include:

• Previous vaginal delivery. Vaginal delivery at least once before or after your C-section increases the probability of a successful VBAC.
• Pregnant with one baby. The more babies within the pregnancy, the higher the risk. VBACs are ideal for low-risk pregnancies.
• Low transverse incision. Suppose a low horizontal incision was used during your previous C-section. In that case, it helps lower help the chance of uterine tearing, which is one risk of a VBAC.
• Nonrecurring indication. If the reason for your first C-section was for the baby’s health and not because of a stalled labor process, the chance of VBAC success increases. Examples include a breech baby or abnormal fetal heart rate tracing.

What the ACOG VBAC guidelines say

The VBAC qualifications mentioned simply identify the ideal candidate; they do not necessarily and automatically disqualify you from being a VBAC candidate. According to ACOG criteria for VBAC, individual circumstances must be considered in all cases. Although the 2017 ACOG VBAC guidelines are most supportive of the practice, they are not enforceable.

The important thing is to find a supportive medical professional and go over your birthing history and facts and let them help you determine whether this is a viable option.

The decision to attempt TOLAC (trial of labor after cesarean) is a preference-sensitive decision, and eliciting patient values and preferences is a key element of counseling…After counseling, the ultimate decision to undergo TOLAC or repeat cesarean delivery should be made by the patient in consultation with her obstetrician or other obstetric care providers.

-ACOG

Pros and cons of having a VBAC

VBAC offers many pros that make it an enticing choice for women who’ve had a previous C-section. Many women are candidates and aren’t aware of the benefits they could enjoy from a natural birth after C-section. In the same breath, the safety for you and your baby is important to consider because VBAC isn’t always safe for every woman.

Pros

• VBAC has a good success rate: It is said that around 68% of those who try a VBAC have a successful run at it. Keep in mind the numbers for VBAC are low because many don’t know it’s an option, nor is it as supported as it should be.
• Recovery is shorter: Vaginal birth recovery is quicker than C-section recovery or repeat C-section recovery. This can change depending on several factors, including perineal tearing, the use of an epidural, and other varying procedures accompanying birth.
• If you desire an unmedicated birth, you can do so with a VBAC: Just like any vaginal birth, VBAC has the options of every pain management method, including none.

All in all, when assessed against a repeat C-section, VBAC poses an immense amount of benefits over the risks.

Cons

• Risk of uterine tears: This a real danger, but the percentage is about below 1%. Although rare, it’s serious and can affect mom and baby.
• Other VBAC risks: They include blood loss and infection. It’s important to talk to your health care professionals and see what risks could affect you and your journey.

Epidural or no epidural?

For VBAC, much like any other vaginal birth, you can choose whatever pain management measures you would like—including epidurals. The use of an epidural during VBAC can increase recovery time and sometimes prohibit freedom of movement depending on its effects on your body.

At the end of the day, it’s all up to you and your preferences for your birth journey and what you have decided in your birth plan.

What of VBAC2C?

VBAC2C sounds just like what it is. It is when a pregnant woman has had two C-sections and wishes to deliver vaginally. The benefits of vaginal birth after two cesarean sections (VBAC2C) involve the safety of vaginal delivery vs. a repeat cesarean delivery. The main risk is an increased chance of uterine tear.

It’s important to note the risk increases from less than 1% to only about 4%. Remember that with each repeat C-section, the risks increase also.

Tips for normal delivery after cesarean

There are some essential things to keep in mind when going for a VBAC. Here are tips for preparing for vaginal birth after cesarean section.

• Ensure your entire birth team is on board. It’s crucial to find a pregnancy care provider that is 100% supportive of your VBAC journey. Having that support for a VBAC vs. a team pressuring or just waiting to throw the C-section option at you makes a world of difference.
• Ensure your delivery place is supportive and has resources to support your decision to do a VBAC. It’s highly recommended to do VBAC in a ready hospital setting equipped to solve and assist with every issue should it arise.
• Double-check the suggested criteria for a successful VBAC. It’s critical to check in with your medical professional about how your first birth went, the ins and outs of your C-section, and how it was done.

Conclusion

It’s always important to measure your options when considering birthing methods. Talk to your health care professionals and make sure you have support when weighing all your options using evidence-based information. There are pros and cons to every birthing decision you make for yourself and the baby.

Only you know your story and desires and can decide the best course of action, using all resources. After that decision, prepare your VBAC birth plan and have your prenatal care and support team in place. I hope the information here will help better shed light on the safety and benefits of VBAC. As more people are made more aware of their options, the numbers will increase, and more will feel empowered to birth in the way they see fit.