Although some doctors will try to discourage it, research shows that 60 percent to 80 percent of women who attempt a trial of labor after a C-section (TOLAC) successfully give birth naturally. Of course, that also means that four out of 10 women were not successful and ultimately had a C-section.
There are some exclusions. A high-risk uterine scar can eliminate you as a candidate for a VBAC. Additionally, some hospitals don’t accept VBAC candidates, citing a lack of staff and resources capable of handling an emergency C-section. If you’ve had a uterine rupture during a previous pregnancy, you’re also ruled out, and if you have a vertical incision in the upper part of the uterus (sometimes referred to as a classical incision), you may also be excluded because of fears of a uterine rupture.
There are many advantages of VBAC. Vaginal delivery comes with a shorter recovery time and a shorter stay in the hospital. You will also get a quicker return on stamina and energy than after surgery. Plus, a vaginal birth is less expensive than a c-section.
There are other considerations. Some women feel that a vaginal delivery is important because they want to participate in the birth process. With a birth coach, women can more fully participate in the process.
There are also future considerations to make. If you plan to continue having children, the VBAC will help avoid the risks of multiple cesarean deliveries.
History of the Process
From 1970 until 2007, a period of 37 years, the delivery rate via cesarean section in the United States increased sharply, rising from 5 percent of all births to more than 30 percent of births. The dramatic rise in C-sections came as practices in the delivery room changed – forceps deliveries and vaginal breech deliveries decreased, while the introduction of electronic fetal monitoring rose. Cesarean rates also rose because doctors became increasingly reluctant to allow natural births after the first cesarean.
However, attitudes began changing as research showed that TOLAC was a reasonable alternative, and the VBAC rates began rising from a baseline of 5 percent in 1985 to more than 28 percent by 1996, mirroring an overall trend to avoid cesareans, which comprised just 20 percent of births in that same year.
Unfortunately, while TOLAC increased, so did reports of uterine ruptures and other complications. Those reports and the professional liability that was engendered resulted in a reverse trend, with VBAC decreasing to 8.5 percent of births and C-sections rising to more than 31 percent of births. Additionally, some hospitals completely stopped offering TOLAC as an option.
The National Institutes of Health examined the VBAC issue in 2010, concluding that TOLAC was a reasonable option for women with a past history of a C-section and requested that hospitals and other medical treatment centers take another look at offering the option.
The Odds of Success
If you’re contemplating a VBAC, take some time to consider the factors that go into a successful natural birth.
Your chances of success are greater if:
1) You’ve only had one prior low transverse uterine incision, which is the most common cut for a C-section.
2) You’ve had a normal pregnancy, and the baby and mother are healthy.
3) Your prior C-section was based on a reason that is no longer valid, such as health at the time.
4) You go into natural labor before or on your due date.
5) You’ve previously had a successful vaginal delivery.
The odds of success are lower if:
1) You are overdue on your delivery date.
2) You have a large baby.
3) There are suspicions that there may be problems with the baby.
4) You’ve had more than two prior C-sections.
The Risks Are Real
Some mothers believe doctors prefer C-section as a way to save time, and thus are wary of attempts to talk them out of a VBAC. But there are some potentially serious risks, including:
1) A failed labor attempt – Labor puts enormous stress on a woman’s body, and scrambling to do a C-section in an emergency poses dangers.
2) Uterine ruptures – During a difficult delivery, the uterus might tear along a previous scar line from a prior C-section. Although it is rare, it is life-threatening if it happens because massive bleeding, infection in the mother and brain damage to the baby can occur. If the uterine tears, it may also be necessary to perform an emergency hysterectomy to stop the bleeding.
Improving the Odds
While it’s always a personal choice, a mother armed with knowledge can always make a more informed decision about whether the VBAC is the right way to go with her pregnancy. Childbirth classes on VBAC may be available in the community, and it’s wise to take one to get up-to-date information on the process while including a partner.
Your health care provider can provide support as well. Make sure that you share your complete medical history, including any previous C-sections you had, with your doctor.
Next, contact your hospital and find out what their history is with VBAC deliveries. A well-equipped hospital capable of handling any emergencies could be life-saving.
Once you’ve made the VBAC decision, allow labor to start naturally rather than taking drugs to induce labor and achieve more frequent and stronger contractions, which can lead to uterine rupture, particularly in the cervix is not responding and is tightly closed.
The final step is mental. Although every precaution and procedure may be followed, births can always have complications. If the placenta or umbilical cord is a problem or the baby is in a wrong or difficult position, the labor may stall, and a C-section may be necessary.
Prepare for that eventuality. As a VBAC candidate, any delivery will be more closely monitored than others in labor, and a team will be standing by just in case.