Pregnancy and you blog

To VBAC or not to VBAC?

By Mary M. Murry, R.N., C.N.M. February 19, 2010

To VBAC or not to VBAC, that is the question. A little misquote of Hamlet here, but the decision about whether to pursue a vaginal birth after C-section (VBAC) can be a weighty one. If you're considering VBAC, ask yourself these questions:

Is VBAC safe for you — and for the baby? VBAC eligibility depends on many factors, including the type of uterine incision that was used for your prior C-section. A low transverse incision (think bikini scar on your uterus) is strongest and least likely to open during another labor. If you aren't sure what type of uterine incision was used, check the operative report from your prior C-section.

The reason for the prior C-section also matters. If the baby was breech or distressed, you may be a good candidate for VBAC. If the baby didn't fit through your pelvis or your cervix didn't dilate, the odds of a successful VBAC may not be as high. Don't take this as an absolute, though. Every baby is different, and every labor is different. I participated in a VBAC for a woman who had a prior C-section because the baby wouldn't fit through her pelvis. The baby I delivered vaginally weighed 2 pounds more and fit just fine!

It's also important to keep in mind that some hospitals don't allow VBACs. Anesthesia must be available at all times in case a C-section becomes necessary, and not all hospitals can afford this luxury. Talk to your health care provider early in your pregnancy to make sure VBACs are allowed where he or she does deliveries. If not, you may need to change providers or hospitals if you want to pursue VBAC.

How strongly do you want a vaginal birth? If you felt cheated out of a vaginal birth after your C-section, you may want another chance — especially if you think you could have delivered the baby vaginally if you'd been given more time. Remember, your feelings are important. Don't discount them. Instead, give your feelings as much weight as any other factor.

Of course, not every woman who's had a C-section wants a VBAC — and that's OK. If you're unsure about VBAC, trust yourself to decide what's best in your case. As long as your health care provider agrees that VBAC is a safe option, I personally believe that you can't make a wrong decision.

Feb. 19, 2010