Vaginal birth after cesarean (VBAC)

Overview:

Vaginal birth after a cesarean (VBAC) is the process of having normal delivery after having a cesarean (c-section). Cesarean is the surgical procedure where a woman undergoes a cut to give birth to a baby. Vaginal birth is the normal delivery of the baby through the vagina. 

VBAC is the normal delivery through the vagina after having a c-section. VBAC is also called a Trial of labor after cesarean (TOLAC). If the TOLAC is successful, the baby will be born by normal delivery, if not another c-section has to be done. 

Indications:

VBAC is a personal preference of women after having a c-section. It is considered:

• Women wanted a vaginal delivery on their first delivery but could not have it due to various reasons
• Preferring vaginal delivery as recovery from the section is longer. 

Various factors should be considered during VBAC. These include:

• Type of the cut during cesarean 
• Number of c-sections
• Medical history and the lack of life-threatening conditions 
• Position of the baby in the womb
• Baby health in the womb 

Contraindications:

• Previous C-section due to nonprogression of labor 
• Age > 35 years 
• High Body mass index (obesity)
• Expecting a big baby or more than one  
• The due date has passed 
• Gap < 18 months between two consecutive pregnancies 
• A medical condition called preeclampsia

Advantages:

• Faster recovery
• Short hospital stay 
• Avoiding surgery 
• Lowering the risks due to c-section
• The advantage of clearing the amniotic fluid from the baby as it passes through the birth canal 
• Improved immunity of the baby as it travels through the birth canal 
• Reduced risks of complications from surgeries like damage to the adjacent organs 
• No scarring 
• Avoids health-related concerns in future 

For successful VBAC:

• Low transverse/horizontal cuts in the previous c-sections. 
• If one of the deliveries is a normal vaginal delivery 
• No other uterine surgeries like fibroid surgeries 
• No history of the rupture of the uterus
• No medical history of fibroids or growths in the uterus that make delivery difficult 
• Going to labor naturally without any necessity of inducing to go into labor 

Before VBAC:

Before undergoing VBAC, the healthcare provider will counsel about the pros and cons of the procedure. They will take details regarding the previous medical, surgical, and medication history during their first prenatal visit and labor. 

Other information regarding previous deliveries, year of delivery, number of deliveries and their types, and delivery outcomes will be enquired by them. Complications during previous deliveries, the weight of the babies, and the gestational age at which the babies were born during previous deliveries will also be asked. 

If the previous babies were born by c-section, the need for the section and its information will be collected. A pelvic examination will be performed to evaluate the likelihood of normal delivery. An individual can also enquire with the HCP about the safety of the VBAC and c-section, reasons for considering or not considering the VBAC, labour induction if it does not start naturally, management of emergencies, and future planning. 

An individual should also have adequate knowledge about the risk of having multiple c-sections on the body. Heavy bleeding, injury to the internal parts, infections due to surgeries, abnormal attachments of the placenta, rupture of the uterus, and adhesions are some of the risks of repeat c-sections. 

During VBAC:

Certain factors will be considered before undergoing VBAC. Out of them the previous scar due to the surgeries is the most important. There are different types of cuts given during c-section. They are:

A transverse or horizontal cut is made in the lower part of the abdomen in the lower thinner part of the uterus. This has the lowest risk of rupturing the uterus when it grows during pregnancy. 

A low vertical cut is made in the lower part of the abdomen in the lower thinner part of the uterus. This has a higher risk of rupturing the uterus when it grows during pregnancy. 

A classical cut is made in the upper part of the abdomen. This also has the highest risk of rupturing the uterus when it grows during pregnancy. These types of cuts are made for premature babies or those at high risk of delivery. 

The cut present on the abdomen need not correlate with the cut present on the uterus. The chances of having a successful VBAC increase with natural labor. Labor can also be induced with medications. An epidural can be taken for pain. 

During labor, the baby’s heart rate will be closely monitored for complications like unusual heartbeat. Mother will also be monitored by checking their vitals regularly and also their pain and bleeding. Any tears in the scars will be checked which necessitates an emergency c-section. 

If the labor progresses smoothly without any complications the baby can be delivered through the vagina normally. Postpartum care is similar to normal delivery. Any tears in the previous scars can be discovered after delivery and heal on their own. 

Risks and complications:

Certain risks associated with VBAC include rupture of the previous scar on the uterus. Uterine rupture is a medical emergency that needs immediate delivery of the baby and immediate closure of the rupture. Uterine rupture during VBAC can also cause complications to the baby. severe blood loss needing blood transfusion, infections, and an emergency c-section. 

Conclusion:

VBAC is the normal delivery of the baby after having a c-section. Based on the reason for the previous c-section and the type of scar and an assessment by the HCP, an individual can have a successful VBAC. VBAC reduces the chance of having a second c-section and helps to deliver the baby vaginally. 

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