Have you had a baby through a C-section before? Let's learn about VBAC (Vaginal Birth After Cesarean)!

Did you have a previous baby by cesarean section? At that time, when you are about to have a baby again, you must have a big question in your mind, "Will I have a normal delivery this time too, that is, through the vagina (vaginal delivery)?" This is a question that many mothers have. So today, let's talk about having a normal delivery after a cesarean section, that is, VBAC (Vaginal Birth After Cesarean).

What is VBAC (Vaginal Birth After Cesarean)? Simply put...

Simply put, VBAC is when you have had one or more previous cesarean sections (C-sections) and then have your next baby delivered vaginally, which is the normal way. You know, a C-section is when the doctor makes a surgical incision in your abdomen and uterus to remove the baby.

The main goal of a VBAC is to give someone who has had a previous C-section the opportunity to have a normal birth in their next pregnancy. However, sometimes, if you have had one or more previous C-sections, having a normal birth can be a bit risky .

There are several things to consider when deciding whether or not to attempt a VBAC. For example:

• The type of incision the surgeon used during your previous C-section and how many C-sections you have had.
• Your health history .
• Do you currently have any other medical conditions ?
• The baby's position and whether the baby has any health problems .

Your doctor will review all of this and tell you whether it is safe for you to try a VBAC. He or she will explain the pros and cons to you. Then, based on that discussion, you can decide whether to try a VBAC or have another C-section.

Studies have shown that about 75% of women who have had one C-section have a successful vaginal birth in their next pregnancy. However, if you have had two or more previous C-sections, your chances of a successful VBAC may drop to about 50% .

Doctors sometimes refer to a VBAC as a TOLAC (Trial of Labor After Cesarean) . TOLAC is an attempt to have a vaginal birth after a cesarean section. If this attempt (TOLAC) is successful, the result is a VBAC. If it is unsuccessful, another C-section will be required.

Why do so many people hope for a VBAC after a C-section?

This is often a personal preference . Some people would like to have a vaginal birth, but for some reason, they are unable to do so. Or they may prefer a vaginal birth because it takes longer to recover from a C-section.

Even if you prefer a natural birth, your doctor may still recommend a C-section due to some of the risks of a VBAC. Or, they may say that it's okay to try a VBAC.

What are the advantages of a VBAC?

There are several advantages to a VBAC compared to a C-section. Take a look:

• Faster recovery and reduced hospital stay: After a C-section, there is a lot of bed rest and time for the incision to heal. These are much less common with a VBAC.
• Not having abdominal surgery: The only big thing to avoid is major surgery.
• Avoiding or reducing the risks of a C-section (such as excessive bleeding, infection).
• Benefits for the baby: During a normal delivery, the amniotic fluid in the baby's lungs is removed as the baby passes through the birth canal. This prepares the baby for oxygen after birth. Also, the baby's immune system is stimulated as it passes through the birth canal.
• The risk of complications (such as scar tissue formation - adhesions, damage to internal organs) that can occur due to repeated surgeries is low.
• Personal preference: Some people have a strong desire to experience a normal childbirth.

Think about it, if you're planning to have more children, it's much more worthwhile to have a successful VBAC than to keep having C-sections. Because every C-section comes with some risk.

What are the risks of trying a VBAC?

A C-section leaves a scar on the uterus. So, the pressure from labor can cause the uterus to tear along the C-section scar (uterine rupture) . This is the main risk of a VBAC. However, recent studies have shown that in most cases, a VBAC can be safely performed after a C-section.

Uterine rupture is a rare but serious complication that can be life-threatening . If you are at high risk of uterine rupture, your doctor will usually not attempt a VBAC.

Other risks that may arise when attempting a VBAC include:

• Blood loss
• Infection
• Emergency C-section: This is riskier than a planned C-section.

What is the risk of uterine rupture?

The risk of uterine rupture for someone who has had a previous C- section, where a low transverse cut was made, is about 0.9%, which is less than one in 100. So, while this is a very low risk, it is important to be aware of it.

Does the incision from a previous C-section affect VBAC?

Yes, it definitely does. There are several types of incisions made during a C-section:

• Low transverse incision: This has a lower risk of uterine rupture. This incision is made across the lower, thinner part of the uterus.
• Low vertical incision: This carries a slightly higher risk of uterine rupture than the transverse incision. This is done lengthwise in the lower, thinner part of the uterus.
• A longitudinal incision in the upper part of the uterus ("Classical" incision): This is the most risky way to tear the uterus. Surgeons may need to make this type of incision when the baby is premature or when the baby is in a difficult position to deliver.

A very important point here is that the location and direction of the scar visible from the outside of your abdomen will not be the same as the location and direction of the incision made inside your uterus. For example, even though your abdominal scar is transverse, the incision in your uterus may be longitudinal.

Your medical records should include details about the location and direction of the incision in your uterus. When you talk to your doctor about the safety of a VBAC, make sure he or she reviews your medical records and any previous C-sections.

Who is more likely to have a successful VBAC?

Talk to your doctor about your health history, current pregnancy, and any factors that led to a previous C-section.

You may have a better chance of a successful VBAC if you:

• If you have only had one or two previous C-sections, even those were done with low transverse incisions in the lower part of the uterus .
• If you have had a previous vaginal birth.
• If you have not had other uterine surgery (e.g. myomectomy ).
• If you have no previous history of uterine rupture.
• You do not have any medical conditions that would make a normal delivery risky (e.g., uterine fibroids, problems with placenta location).
• If you start labor spontaneously, before your due date.

If you have had a successful VBAC before – without complications such as uterine rupture – you are more likely to have successful vaginal deliveries in the future.

In what situations are the chances of a VBAC being successful reduced?

Sometimes, the chances of a VBAC being successful may be reduced for reasons such as:

• The previous C-section was done because labor was not progressing . That is, if your cervix did not open (dilate) or efface (shorten) properly during a normal delivery.
• If you are over 35 years old.
• If you are obese or overweight.
• If you are expecting a large fetus or are expecting multiples.
• If your due date has passed.
• If you get pregnant again less than 18 months after having your previous baby (short time between pregnancies) .
• If you have preeclampsia (doctors are more likely to perform a C-section at this time).

What are the risks of repeated C-sections?

There is no set number of C-sections you can have. However, some studies show that people who have many C-sections have higher risks, such as:

• Heavy bleeding.
• Bladder and bowel injury.
• Infection.
• Placental conditions in a future pregnancy, for example, abnormal attachment of the placenta to the uterus ( placenta previa or placenta accreta ).
• Uterine rupture.
• Adhesions (sticking together of scar tissue).

These risks can vary from person to person. It depends largely on your health history, and the specific circumstances of each pregnancy and delivery. So, your doctor is the best person to talk to about the pros and cons of having another C-section or trying a VBAC.

What questions should you ask your doctor about VBAC and a repeat C-section?

Like a VBAC, a C-section has both benefits and risks. So, it's important that you understand both birthing methods and how they affect you.

Discuss these issues with your doctor:

• About your previous pregnancies and births .
• What factors led you to have a C-section ?
• How safe is a VBAC and a C-section for you and your baby?
• What are the reasons you should consider/not consider a VBAC ?
• What are the reasons you should consider/not consider a C-section again ?
• A plan for inducing labor (whether or not there is one).
• Whether the hospital where you are going to deliver your baby can handle emergencies .
• About your plans to have more children .

Just because you had a previous C-section doesn't mean you can't have a VBAC in the future. You may have heard or read that scarring after a C-section can cause problems in future pregnancies. However, everyone's situation is different.

Finally, things to remember

Early in your pregnancy, talk to your doctor about your wishes and concerns about a VBAC. He or she can explain the pros and cons to you and help you decide if a VBAC is safe for you. As your pregnancy progresses, it is important to continue talking to your doctor and reviewing your birth plan. Remember, every pregnancy is unique, so work with your doctor to make the decision that is best for you.

` VBAC, cesarean, C-section, normal delivery, pregnancy, uterine rupture, childbirth