VBAC stands for ‘vaginal birth after caesarean’. This term is used when women give birth or plan to give birth vaginally after previous caesarean birth. Vaginal birth includes normal delivery and delivery assisted by forceps or vacuum cup (ventouse).
What choices do you have in managing your pregnancy pathway?
Women who have had a caesarean birth before will have a consultation during the course of pregnancy with either a consultant obstetrician or consultant midwife or designated deputy to discuss individual risks and options.Women can choose either VBAC or planned elective caesarean, an operation to deliver the baby after 39 weeks of pregnancy. The plan will be reviewed with you throughout pregnancy. You can change your mind and you should discuss any questions with your midwife or obstetrician. In case of any emergency please call your local maternity unit.
Are all women suitable for VBAC?
Not all women are recommended for VBAC. In your first/subsequent pregnancy after an LSCS you may have been given a letter which explains your options. At the consultation the obstetric doctor or specialist midwife will discuss your options with you, and review your previous notes, if available. An individualised plan will be agreed with you that will be reviewed throughout your pregnancy.
VBAC facts
More than one in five women in the UK may have experienced birth by LSCS. Around half of these are planned and the other half as an emergency. VBAC is generally only offered to women with a singleton pregnancy with the baby in the head down position, who have had a lower segment caesarean section (LSCS).Chances of success are approximately 72-75%. A number of factors affect the success rate of VBAC. These include maternal weight, your health, and whether your labour starts spontaneously. Women who have an interval of less than a year from a previous LSCS are not at greater risk of scar rupture, but are more at risk of having a preterm birth. It is generally advised that there should be at least a year between births. Women who have had two or more caesarean births can be offered the opportunity for VBAC after counselling. Success rates are similar (62-75%). If you have had a successful VBAC previously you have an 85-90% chance of successful VBAC the next time.
What are the risks associated with VBAC?
There is a 1:200 (0.5%) chance of scar rupture, this increases significantly if you are induced. Induction with amniotomy (artificial rupture of the membranes) or balloon catheter is associated with a lower risk of scar rupture compared to using prostaglandins (medical method). Approximately 25% of women in labour will need an LSCS. An emergency LSCS has more risk than a planned LSCS, and you may have a higher chance of haemorrhage, leading to the need for a blood transfusion in this situation. Your chance of experiencing bladder or bowel injury during an emergency procedure is higher than in a planned procedure. Complications for baby are similar to a woman birthing a baby for the first time. You may require an assisted birth, or experience perineal trauma involving the back passage (anus). Estimated birth weight may be a factor in the risk affecting perineal trauma.
What are the advantages of a successful VBAC?
If you have a successful VBAC it is associated with fewer complications than a planned LSCS. Your recovery is likely to be quicker and you should be able to return to normal activities sooner. Your hospital stay is likely to be shorter. Your baby is likely to have less chance of breathing difficulties.
When is VBAC not advisable?
Planned VBAC is not recommended if you have experienced a previous uterine rupture or have classical caesarean scar (a vertical scar on the tummy) or if there are other pregnancy or medical/health complications, or previous uterine surgery.
What happens during labour for women experiencing VBAC?
You will normally be advised to labour in the hospital’s labour ward. You are advised to call the hospital when you have regular contractions or your waters have broken. Continuous monitoring of the baby’s heart rate is recommended. There are a range of pain relief options, and you will be advised about having an intravenous needle inserted in your hand for fluid management. If you choose not to give birth in hospital then you are normally seen by a specialist midwife or consultant midwife who will create an individualised plan with you.
What happens when labour does not start spontaneously?
If you are not in spontaneous labour by 40 weeks you will normally be seen in the antenatal clinic and assessed. You will be given options that include induction (IOL) with prostaglandins (medical method), induction with amniotomy (artificial rupture of the membranes) or balloon catheter, or to wait another week. Delivery by LSCS will be discussed with you on an individualised basis. Any decision relating to induction of labour or LSCS will take into consideration any risks for you and your baby.
