VBAC

So you've had a cesarean - does that mean your other births must be a cesarean?  No! In fact, a VBAC (vaginal birth after cesarean) may be a safer option for you and your baby. What about 'once a cesarean, always a cesarean'? -Evidence shows otherwise; surround yourself with support and encouragement, educate yourself, hire a doula, choose your birth place and care provider carefully and avoid induction to improve your chances for a successful VBAC.

What are the benefits of a vbac?

An official statement by ACOG says

a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans

See the full article.

 

Bonding

Labor is an intricate dance of hormones; the most important of these- the "hormone of love" -oxytocin. This is not to say that you can't bond with your baby if they are born via cesarean but this very important hormone that enhances the bonding experience is lost in an [elective] cesarean section.  A cesarean section is major abdominal surgery and can be painful to recover from.  This associated pain can inhibit the bonding you experience during breastfeeding and can make breastfeeding more difficult. When a baby is born via c-section milk may take a few extra days to come in- don't let this discourage you.

 

The Big Squeeze

When a baby is born vaginally, fluid is expelled from the lungs when the baby is 'squeezed' through the birth canal. When a baby is born via cesarean section this factor is lost and can result in faster, shallower breathing; this is usually resolved within 24-48 hours. Another benefit lost to cesarean section would be delayed cord clamping.

 

What about a uterine rupture?

According to a recent UK study, the risk of uterine rupture is .2%; the study goes on to say

For women with a previous cesarean section, risk of uterine rupture increases with number of previous cesarean deliveries, a short interval since the last cesarean section, and labour induction and/or augmentation.

The fear of uterine rupture is the most common concern I hear in regards to a VBAC; according to the NIH consensus, 99.5% will remain intact. [This blog shares the evidence for decreased risks after multiple VBAC's.] There are risks associated with both an RCS (repeat cesarean section) and a TOLAC (trial of labor after cesarean)- the problem lies in that most women who are considering a VBAC are told of the risks associated with a trial of labor but not the risks associated with a cesarean section.

 

Risks of Cesarean

Risks for Mother	Risks for Baby
·         Infection ·         Longer hospital stay ·         Hematoma ·         Return to hospital ·         Extended recovery time ·         Injury to organs ·         Ongoing pain (6-12months post delivery) ·         Chronic pelvic pain ·         Hemorrhage ·         Mortality ·         Negative emotional reactions	·         Respiratory problems ·         Pulmonary hypertension ·         Difficulty breastfeeding ·         Premature birth (in a planned cesarean) ·         Fetal Injury ·         Lower APGAR scores
Risks for future pregnancies
Risks are greater after 2 or more cesareans. It is recommended to have a minimum of 18 months before a TOLAC.       ·         Placenta previa       ·         Placenta accreta       ·         Placental abruption ·         Uterine rupture

The fact of the matter

VBAC Support

Cesareans don't just require physical healing, they impact us emotionally and socially as well.  Both mothers and babies benefit from a successful VBAC with fewer complications, easier breastfeeding and a more positive outlook of the birth experience. There are many factors that go into achieving your VBAC, the most important of which is support.  Finding a care provider who will support you and a birth place where you are comfortable are critical components. You will probably find doula support to be indispensable -- a doula will support you prenatally as well as offer emotional [and physical]comfort during labor, which may be a central component to your VBAC. For online resources and to find support in your area, visit my helpful links tab.

Above all, be empowered in your birth by making an informed choice on this Journey of Life. I hope this blog post can help support that decision and would love for you to share your VBAC story here!