Is a VBAC Safe? Exploring the Pros and Cons
- Lucy Vann-Patrick
- Jan 20
- 4 min read
If you’ve had a caesarean section (C-section) in the past and are considering your options for future births, you might have come across the term VBAC (vaginal birth after caesarean). It is an option for parents looking to experience a vaginal birth, but naturally, questions about its safety might arise. Let’s dive into what VBAC entails and whether it’s a safe choice for you.
What is a VBAC?
VBAC stands for vaginal birth after caesarean. It refers to giving birth vaginally after having had at least one C-section. (2x c-sections is VBA2C, 3x c-sections VBA3C so on and so forth). For many parents this is the option they want to explore, and their reasons may vary but all are valid.
We might also see VBAC’s as TOLAC (Trial Of Labour After C-section) I will only refer to this as VBAC as I find TOLAC very judgemental and not very helpful.
The Safety of VBAC: What Does Research Say?
The safety of VBAC has been studied but ONLY in medical conditions so we need to take into account that there was a medical care plan put in place which will skew the results, not only this but it tends to be on the success of a VBAC not the experience of a VBAC.
According to the American College of Obstetricians and Gynecologists (ACOG) and Royal College of Obstetricians and Gynecologists (RCOG) approximately 60-80% of individuals who attempt VBAC are successful. This means they go on to birth vaginally without complications. However, looking at the rates of births after a previous c-section verses the national average a lot of the trusts are falling short.
Benefits of VBAC
Shorter Recovery Time: Compared to a repeat C-section, recovering from a vaginal birth is usually quicker and less physically demanding.
Lower Risk of Surgical Complications: Avoiding surgery means less risk of infections, blood clots, and anesthesia-related complications.
Reduced Risk in Future Pregnancies: Each C-section increases the risk of complications like placenta previa or placenta accreta in subsequent pregnancies.
Emotional Benefits: For some parents, having a vaginal birth can be a healing experience, especially if their previous C-section was associated with trauma.
Risks of VBAC
While VBAC is safe for many, it does come with some risks, the most “significant” being uterine rupture. This occurs when the scar from the previous C-section tears during labor. Though rare (happening in about 0.14-1% of VBAC attempts)(1), it can be life-threatening for both the parent and the baby if it occurs. Emergency medical care is crucial in such situations.
Other risks include:
Need for an emergency C-section if complications arise (as is the same for all other labours)
Factors That may Influence VBAC Safety
Not everyone feels safe having a VBAC. You can look at several factors to help you decid if you feel this is a safe option.
Type of Uterine Incision:
A low transverse incision (horizontal cut) is the most common and has the lowest risk of uterine rupture.
A vertical incision or a T-shaped scar may increase the risk, making VBAC less advisable.
Reason for the Previous C-section:
If the C-section was due to issues unlikely to recur (like a breech baby, although this is not a medical reason).
Number of Previous C-sections:
While people with more than one previous c-section still can have a c-section, your provider might be less accommodating. It is important to understand the reasons behind the c-sections and the risks assosicated with them.
Overall Health:
Contraindications may play a factor in how you perceive the risks with your next pregnancy.
Timing and Spacing Between Pregnancies:
A longer gap between your C-section and the current pregnancy reduces the risk of complications. While not associated with an increased risk of Uterine rupture other factors such as pre-term birth might be something to consider. (2)
Hospital and Provider Support:
Not all hospitals or providers are supportive of VBACs. Ensure that your chosen your birthing team that is supportive of your wishes.
Preparing for a VBAC
If you decide that VBAC is a safe option, there are steps you can take to increase your chances of a successful experience:
Choose a Supportive Provider: Work with a healthcare provider experienced in VBACs who can guide you through the process.
Stay Healthy During Pregnancy: Maintain a balanced diet, stay active, and attend all prenatal appointments to monitor your progress.
Get informed: make sure you know what you want for your labour and
Be Open to Outcomes: While planning for VBAC, it’s essential to remain flexible. Always plan for a c-section along side your VBAC.
When is VBAC Not Recommended?
There are circumstances where VBAC is not considered safe. These include:
A previous uterine rupture.
A vertical or high-risk uterine scar.
Certain medical conditions that make labour unsafe.
Lack of access to emergency surgical care.
Ultimately these are your risks and even if these risks are present you can still decide to go ahead and birth your baby.
Emotional Considerations
For parents who have experienced birth trauma, the decision to attempt a VBAC can feel overwhelming. It’s important to address these emotions and seek support when needed. Joining support groups or talking to a therapist experienced in birth trauma can be helpful.
VBAC can be a safe and empowering choice for many parents. By understanding the risks and benefits, and preparing for different outcomes, you can make the best decision for your body and baby.
Remember, there’s no “one-size-fits-all” answer when it comes to birth. Whether you choose a VBAC or a repeat C-section, the goal is a healthy parent and baby. Trust your instincts, stay informed, and know that whatever path you take is the right one for your family.
Find out more about the Positive Birth After C-section Course here.
If you’ve had a VBAC or are considering one, we’d love to hear your thoughts and experiences. Share your story in the comments below!
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