VBAC: Insight from a Mayo Clinic specialist
Wonder if you're a good candidate for VBAC? If the benefits of VBAC outweigh the risks? The answer might be up to you. Here's help weighing the pros and cons.By Mayo Clinic Staff
Many women are candidates for vaginal birth after cesarean (VBAC). Still, the choice to pursue VBAC or schedule a repeat C-section can be difficult. Here's insight on how to make the decision.
Why would a woman consider VBAC?
Compared with having another C-section, a vaginal delivery involves no surgery, a shorter hospital stay and a quicker return to normal daily activities. VBAC might also be appealing if you have an emotional investment in a vaginal delivery or a desire to experience vaginal childbirth.
It's important to consider future pregnancies, too. If you're planning more pregnancies in the future, VBAC might help you avoid the risks of multiple cesarean deliveries, such as bowel or bladder injury and placenta problems.
What are the risks of VBAC?
The most obvious possible risk is failed labor. In fact, research on women who attempt a trial of labor after cesarean (TOLAC) shows that about 60 to 80 percent have a successful vaginal delivery.
The most concerning risk of VBAC is uterine rupture — when the uterus tears open along the scar line from a prior C-section or major uterine surgery. If your uterus ruptures, an emergency C-section is needed to prevent life-threatening complications, including heavy bleeding and infection for the mother and brain damage for the baby. In some cases, the uterus might need to be removed (hysterectomy) to stop the bleeding. If your uterus is removed, you won't be able to get pregnant again.
Other risks of a failed TOLAC include surgical wounds, bleeding complications that require a hysterectomy or transfusion, and infection.
Can you put the risk of uterine rupture into perspective?
Uterine rupture is rare, occurring in less than 1 out of 100 women. If you're considering VBAC, make sure that the facility where you'll deliver the baby is ready to deal with that complication. You'll need staff immediately available to provide emergency care.
July 02, 2015
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- Wells CE, et al. Choosing the route of delivery after cesarean birth. http://www.uptodate.com/home. Accessed May 19, 2015.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 115: Vaginal birth after previous cesarean delivery. Obstetrics & Gynecology. 2010;116:450.
- Berghella V. Cesarean delivery: Preoperative issues. http://www.uptodate.com/home. Accessed May 19, 2015.
- Lang CT, et al. Uterine dehiscence and rupture after previous cesarean delivery. http://www.uptodate.com/home. Accessed May 19, 2015.
- Hauk L. Planning for labor and vaginal birth after cesarean delivery: Guidelines from the AAFP. American Family Physician. 2015;91:197.
- Shachar BZ, et al. Interpregnancy interval and obstetrical complications. http://www.uptodate.com/home. Accessed May 19, 2015.