VBAC Birth - Vaginal Birth After Caesarean
Why do women who have previously had a c section want to have a VBAC? There are many reasons why a woman chooses to have a VBAC. I have listed a few of them here.
1- To experience a vaginal birth, many women who have had previous c sections have the urge to experience vaginal childbirth. The reason for this varies between women and can be deeply personal, the circumstances surrounding their previous birth may also play a part in their desire to experience a vaginal birth.
2- Healing from a previous birth experience
3- Risks of VBAC compared to risks of a repeat c section
4- Avoids major surgery
5- Much faster and less painful recovery
6- Better mobility
7- Lowers risks involved with future pregnancies
8- Allow for a physiological birth, which includes hormonal processes for higher positive outcomes for mum and baby, including gut colonisation, liquid ejection from baby’s lungs, stronger immune system for baby and increased positive experience with bonding and breastfeeding.
9- Mother is in control and making the decisions for her birth
10 -Looking for an empowered birth experience
Things that should be considered
Which care provider do I go with?
When looking at which care provider you want to go with for you VBAC pregnancy and birth it is definitely not one size fits all, you should be looking for a VBAC supportive care provider, someone who you trust and who genuinely want to put your needs and wants ahead of their own “opinion” Someone who can without bias explain to you what the objectives are, what are the risks, what are the benefits as well as possible complications and the anticipated results. You also want a care provider who is going to inform you, give recommendations based on the science based evidence and then no matter what you decide you want to do, will support you wholeheartedly and continue to inform you and involve you in decisions throughout the process.
Decision making around VBAC - is a VBAC right for me and my baby
*RANZCOG guidelines - These guidelines are based on the general consensus and opinions of healthcare professionals.
https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Birth-after-previous-Caesarean-Section-(C-Obs-38)Review-March-2019.pdf?ext=.pdf
RANZCOG VBAC Information https://ranzcog.edu.au/womens-health/patient-information-resources/vaginal-birth-after-caesarean-section
*ACOG guidelines and statistics - Based of evidence based research
https://www.aafp.org/afp/2004/1001/p1397.html
Ideal vs not ideal candidates - more information on this below in RANCOG info link
*Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should be counselled about VBAC and offered a trial of labour.
*Women with a vertical incision within the lower uterine segment that does not extend into the fundus are candidates for VBAC.It is not recommended to attempt a VBAC or labour with a previous “classical” caesarean scar.
Birth intervals - There is not a lot of research data on the risks of short vs long birth intervals in regards to VBAC. The studies that we do have are small and often limited. It is recommended that waiting 18-24 months between becoming pregnant is more favourable, this is for all women not just women wanting to attempt a VBAC. If your birth interval is shorter than 18-24months and you would like more information on birth intervals let me know and I can provide you with this study material.
Risks of VBAC
Uterine rupture - A uterine rupture refers to the incident of the cesarean scar on the uterus breaking open. Uterine rupture is rare, happening in less than 1% of women who attempt a trial of labor after cesarean. However, uterine rupture can be life-threatening for you and your baby. If this occurs an emergency C-section is needed to prevent life-threatening complications.
The Landon Study (2004) - Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery (Attempted VBAC)
This study is one of the largest studies done on VBAC attempt that was cited by governing bodies, the statistics from this study are therefore very reliable due to its large sample size of participants.
This study reported a uterine rupture rate of 0.40% or 1 in 240 women with one prior low transverse caesarean section during a non-induced or augmented planned
VBAC.
Here are the statistics for uterine rupture based on type of labour, as you can see augmented or induced labour does double the risk but statistically this rate is still very low.
Spontaneous labour – 6685 women – 0.40%
Augmented labour – 6009 women – 0.90%
Induced labour – 4708 women – 1.00%
Link to the LANDON study
https://www.nejm.org/doi/full/10.1056/NEJMoa040405
Some other interesting numbers to look at (from 2010 Komorowski Study)
Uterine rupture happens in about 7-8 out of 1000 VBAC attempts.
Placental abruption happens in about 11-13 out of 1000 labours
Cord Prolapse happens in about 14-62 out of 1000 labours
Shoulder dystocia happens in about 6-14 out of 1000 labour
Main signs of uterine rupture (most common to least common)
54% - abnormal pattern in foetal heart rate over an extended time
40% - Uterine tachysystole (hyperstimulation)
37% - vaginal bleeding
26% - abdominal pain
4% - loss of intrauterine pressure or cessation of contractions
Other signs may include
-Abdominal pain or tenderness between contractions (between contractions there should be no pain)
-A sharp onset of pain at the site of the previous scar. That's because over 95% of uterine ruptures in a scarred uterus occur along the scar line
-Contractions slow down or become less intense
-Baby's head moves back up the birth canal
-Bulge in the abdomen or under the pubic bone. This could be where the baby is going through the uterine opening into the abdominal cavity (and these babies have the worst outcomes)
-Uterus becomes soft
-Shoulder pain
Benefits of VBAC
- Avoids surgery
- Lower maternal mortality and morbidity
- Faster and easier recovery
- Lower risk in future pregnancies
- Emotionally healing
- Positive effects of physiological birth
- Hormonal high
- Biologically normal
- Gut colonisation
- Stronger immune system for baby
Repeat C section (RCS) risks
Risks associated with RCS increase with each additional c section. C sections are classified as major abdominal surgery, and carry these risks for both mother and baby. RCS greatly increases the likelihood of complications for future pregnancies. The main concern is heightened risk of developing placenta accreta (where the placenta abnormally attatches to the uterine wall) placenta increta (where the placenta goes into the uterine muscle) or placenta percreta (where the placenta goes through the uterine wall and adheres to other abdominal structures, most commonly the bladder) Placenta previa risk is also increased with each additional c section.
These types of placenta abnormalities carry high risk for both mother and baby, and can cause such complications as haemorrhaging, the need for blood transfusion, a maternal ventilator, caesarean hysterectomy, maternal mortality and perinatal mortality.
Benefits of Repeat C section
- Lower risk of perinatal mortality (1 in 2000)
- Lower risk of uterine rupture (1 in 3,333 for CBAC/ 1 in 240 for VBAC)
- You are able to plan
- Longer hospital stay and immediate support
- Avoid time and intensity of labour pain
- May be best for sexual abuse victims and emotional trauma
If you would like more information about VBAC let me know, I am always happy to have a chat
X Sasha
