V.B.A.C. Vaginal Birth After Cesarean
V.B.A.C. Vaginal Birth After Cesarean
Today many women are choosing to have a vaginal birth after a cesarean section. Most modern
cesareans are done with a horizontal incision low in the uterus (the "low transverse incision" or
"bikini cut"). This part of the uterus is fibrous, stretchy, and strong. It heals very well. Low
transverse scars rarely rupture (in fact only about 1/2 of 1% which is about the same risk as a
mother who has never had a cesarean). Experts now say that for healthy mothers with low
transverse scars, labor and vaginal birth are less risky than routine repeat cesarean. The age old
phrase "Once a cesarean always a cesarean" is no longer valid and with a few exceptions most
women can and should try for a vaginal birth after a cesarean. Even a woman who has had two
or more previous cesareans (low transverse/bikini cuts) should be encouraged to give birth
vaginally. Also, women with a previous low-vertical scar are being allowed a trial of labor under
close scrutiny.
Vaginal birth is inherently safer than a cesarean (or repeat cesarean) simply because a cesarean
is major surgery. Surgery carries its own special risks and should not be chosen simply for
convenience of parents or doctor. The risks of major surgery include infection, hemorrhage,
anesthesia (whether it be general or local such as an epidural), and inadvertent injury to internal
structures due to surgery. If a mother gives birth vaginally, she can avoid these risks. However
when there is a medical need, the lifesaving techniques used in the cesarean are very much
appreciated and warranted.
Why do some women choose a VBAC and not a repeat Cesarean?
There are many benefits to having a vaginal birth after a cesarean. Many women choose this
route for a number of reasons. Some of these reasons are listed below:
- Overcoming feelings of inadequacy
- Safety of mother and child (vaginal birth is safer than surgery for both)
- Finances - vaginal birth is less expensive
- Greater sense of involvement
- Less pain after the birth
- Sense of accomplishment
- Benefit that labor has on the baby and less chance of a premature baby
- Less blood loss and therefore less need for blood transfusion
- Father allowed to share in the birth experience more
What are the benefits of a vaginal birth after a cesarean?
The benefits of vaginal birth are broken down into categories. These categories include the
following:
- Medical
- Prevention of death of mother (the risk of death is 2-4 times higher with a cesarean)
- Prevention of infections, one of the most common complications of cesarean section.
The most common of these are endometritis, wound infections, and bladder infections.
- Prevention of blood loss - with a vaginal birth blood loss is only a little over a pint as
opposed to cesarean section where the total blood loss can be almost a quart.
- Prevention of urinary tract injury - this occurs 3 times more often in repeat cesareans
because of adhesion (internal scar tissue) formation.
- Prevention of bowel injury - postoperative ileus, a condition in which the bowels stop
functioning and the intestinal contents tend to cause blockage causing severe abdominal pain
and vomiting, is not uncommon.
- Prevention of hysterectomy due to the placenta connecting so low it covers the cervix
preventing the baby from coming out and penetrating so deeply into the uterine wall that it
cannot be removed called placenta previa accreta.
- Psychological - VBAC might help women to avoid the following emotional problems:
- Concern about their inability to deliver vaginally, especially if childbirth preparation
classes were taken.
- Loss of the ability to witness or participate in the birth.
- Loss of being allowed to have a significant person attend and participate as desired.
- Loss of control, or feeling a sense of powerlessness over the events surrounding the
birth experience.
- Loss of, or interference with, the opportunity to immediately interact with the newborn
baby. Loss of the immediate postpartum mother-infant bonding process.
- Feelings of inadequacy or loss of "womanliness" because of the inability to produce a
baby the "natural way".
- Feelings that parts of the birth process have been taken away.
- Longer loss from undertaking roles viewed as essential to the mother's self-concept,
such as mothering the new baby, taking control of the household, and interacting with other
children.
- Postoperative depression.
- Feelings of loss or guilt for not being able to mother the new baby adequately.
- Physiological - Breastfeeding issues:
Women who have had a cesarean section can breastfeed, however it is
more difficult. Many women who want to breastfeed immediately after birth cannot achieve this
since immediately after the operation the baby is usually taken to the nursery while the mother is
stitched up. This important bonding time can be interrupted for upwards to 4 hours following the
birth. With a vaginal birth, the mother can breastfeed immediately in most cases. Also,
breastfeeding after a cesarean section can be painful, as the baby is usually cradled over an
unhealed surgical incision. Vaginal birth mothers vary rarely experience any pain in
breastfeeding directly after birth and even find the experience to be helpful in expelling the
placenta preventing the need for pitocin to expel the placenta from the uterus.
- Financial
The average cesarean section costs approximately $3,000.00 more than a natural vaginal birth.
For some couples this does not seem to be an issue as their insurance will cover all costs either
way, however it should be noted that for those couples who have a copayment their costs can
end up being $2,000.00 or more. This extra expense can be attributed to extra hospital days
required to recover, cost of surgicalrue that the surgery of today is much safer than it was fifty
years ago, the fact remains that it is still surgery which adds many unnecessary risks that, when
done on a whim, could be safely avoided.
Should special classes be taken in preparation for a VBAC?
Whenever possible, it would be to the advantage of couples attempting a vaginal birth after a
cesarean to attend special classes geared toward helping the pregnant couple understand the
special needs and preparations necessary for a successful VBAC and to help them deal with the
emotional issues surrounding the previous birth experience.
What other steps can I take to help me have a succesful and positive VBAC experience?
Hiring the services of an experienced doula or professional labor assistant can also provide a
greater ability for a positive VBAC experience. This person can provide a sense of stability and
help the remind the mother of the normalicies of birth and assurance to the laboring woman that
what she it experiencing at that moment is normal.
