Is it possible to have a normal baby after a cesarean section? (VBAC - Vaginal Birth After Cesarean) Let's talk about this!

If you had a previous baby by cesarean section ( C-section ), you may be wondering if you can have your next baby delivered vaginally. This is a question that many mothers have. So today, let's talk about VBAC, which is vaginal birth after a cesarean section.

So what is VBAC?

Simply put, VBAC is an abbreviation for 'Vaginal Birth After Cesarean'. In Sinhala , it means giving birth vaginally after a cesarean section . As you know, a cesarean section (C-section) is a surgery to remove the baby by making an incision in the abdomen and uterus. So, for someone who has previously had a cesarean section, we call it VBAC when they try to give birth to their next baby naturally, that is, without surgery, vaginally.

What should we consider before considering a VBAC?

The main purpose of a VBAC is to give a woman who has had a previous cesarean section the opportunity to have a vaginal birth in her next pregnancy . However, if you have had one or more cesarean sections, sometimes having a vaginal birth can be a bit risky . So there are a few things to consider when deciding whether to try a VBAC.

They are:

• The type of incision used in your previous cesarean section and whether you have had more than one cesarean section.
• Your health history , meaning things like previous illnesses you've had.
• Whether you currently have any other medical conditions (e.g., diabetes mellitus , high blood pressure ).
• The baby's position and whether the baby has any known health problems .

Your doctor will review all of this and tell you if it's safe for you to try a VBAC. They will then discuss the pros and cons with you. Then, based on that discussion, you can decide whether to try a VBAC or have another cesarean section.

What are the chances of a VBAC being successful?

Research shows that about 75% of women who have had one cesarean section, or about three out of four, have a successful vaginal birth in their next pregnancy. However, if you have had two or more previous cesarean sections, your chances of a successful VBAC may drop to about 50% .

Sometimes doctors also use the term 'TOLAC' (toll-ac) when talking about a VBAC. TOLAC stands for 'Trial of Labor After Cesarean'. This means trying labor pains after a cesarean section. If this TOLAC is successful, the result is a VBAC. If it is not successful, another cesarean section will be performed.

VBAC and repeat C-Section: Pros and Cons

It is very important to have a clear understanding of the advantages and disadvantages of both methods before choosing them.

Is a previous C-section important when considering a VBAC?

Yes, it is definitely important. There are different types of incisions used in cesarean sections.

• Low Transverse Incision: This is the type of incision with the lowest risk of uterine rupture. In this, the incision is made across the lower, thinner part of the uterus.
• Low Vertical Incision: This involves making a top-to-bottom (vertical) incision in the lower, thinner part of the uterus. This carries a slightly higher risk of uterine rupture than a lower transverse incision.
• High Vertical Incision (“Classical” Incision): This involves making a vertical incision in the upper part of the uterus. This type of incision carries the highest risk of uterine rupture.

The important thing is that the location and direction of the incision on your abdomen are not always the same as the location and direction of the incision on your uterus. For example, your abdominal scar may be horizontal, but your uterine scar may be vertical. So when discussing a VBAC, be sure to check your medical records to confirm the type of incision.

Who is more likely to have a successful VBAC?

A VBAC is generally more likely to be successful in the following situations:

• If you have had one or two previous cesarean sections, even if they were done with low transverse incisions .
• If you have previously given birth normally (vaginally) .
• If you have not had other uterine surgery (e.g., hysterectomy).
• If you have no previous history of uterine rupture .
• If you do not have any medical conditions that would make vaginal delivery risky.
• If you start labor naturally before your due date.

What are the circumstances that may reduce the chances of a VBAC being successful?

Also, the chances of a VBAC being successful may be slightly lower for the following reasons:

• Previously, a cesarean section had to be performed because labor was not progressing .
• If you are over 35 years old .
• If you are obese or overweight .
• If you are delivering a large fetus or expecting multiples .
• If you are past your due date .
• If you have had a previous baby and are pregnant again less than 18 months later .
• If you have preeclampsia .

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