Vbac is the term used when referring to a pregnant woman having a vaginal deliver when she has had a previous cesarean section or c-section. According to the U.S. Centers for Disease Control and Prevention, the vbac rate fell by almost 70% in the last ten years. However, studies show many women who choose a c-section could have a safe vbac.
According to the American College of Obstetricians and Gynecologists(ACOG), the saying "once a cesarean, always a cesarean" dominated the practice for about 70 years, but began changing about 30 years ago due to improvements in obstetric care.
Here's a message I received from a reader:
"Hi Jen! I recently viewed your site and have a question that I would love for you to further investigate. My husband and I would like to have another child; however, prior to becoming pregnant again I am hoping to gather more information on the safety of vbac deliveries and their popularity in the Peoria area."
Are vbacs safe? Dr. Michael Leonardi from Maternal Fetal in Peoria, Illinois says in a small number of women, the stitches from a previous c-section can tear, causing a uterine rupture and putting the baby and the mom in immediate danger. However, he says 60-80% of women who have a cesarean section can have a safe vaginal delivery the next time. He says women who have had one successful vaginal delivery, then had a c-section and are pregnant with a third child are the best candidates for vbac.
Is there anyone who should stay away from a vbac? Dr. Leonardi says women who live in rural areas and will be delivering their baby in a smaller hospital should probably avoid a vbac.
So what kind of hospital is best for vbacs? Dr. Leonardi said, "Do it in a teaching hospital, not an outlying area. An obstetrician and an anesthesiologist need to be in the hospital in case there are complications. If the wound from a previous c-section tears, an immediate cesarean section would have to take place or there would be a catastrophic outcome."
What doctors in town perform vbacs? Dr. Leonardi says all obstetricians can do vaginal deliveries after c-sections. You don't have to go to a specialist. However, he says to stick with an obstetrician as opposed to a family practice doctor who does deliveries. He also says to find out how the doctor feels about vbacs. Dr. Leonardi said, "Pick someone who is middle of the road rather than one extreme or the other. Ask a lot of questions and find someone who spends a lot of time with you. Don’t be pushed to do one thing or another."
Which is safer a vaginal delivery or a c-section? Dr. Leonardi said, "The recovery is faster for a vaginal delivery. In general, babies get a better start in life. Water gets out of their lungs quicker and there is less risk for a transfusion. However, repeat c-sections usually do just fine. " He says women can get into trouble if they are having 5 to 6 babies and deliver all of them through c-section.
Do you have any tips for ensuring a safe vbac? Dr. Leonardi says not to be induced if you want to have a successful vbac. Induction is more likely to lead to a cesarean.
What would you do if it was your wife? Dr. Leonardi answered, "There is a very small risk for the scar separating or rupturing about 1/150. If that happens, an emergency c-section is usually fine, but 1/1000 has a catastrophic outcome. So, vbacs are fairly safe."
Why are fewer people having vbacs? "The number of people having vbacs between 1989-1996 was close to 30%, now it’s more like the 13%. Some of that is based on fear of a bad outcome, some is based on people wanting to schedule their delivery, some is because people want their tubes tied at the same time, " said Dr. Leonardi.
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