This document discusses vaginal birth after cesarean (VBAC). It defines VBAC as giving birth vaginally after a previous cesarean section. It notes that while VBAC can reduce recovery time, there are risks like uterine rupture. The risks and benefits of VBAC versus repeat cesarean section are debated. While VBAC is generally safe, its rates have declined due to physician and patient preferences and more conservative guidelines around emergency care. The document recommends consulting physicians to understand risks before deciding on a delivery method.

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VBAC
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(13 April 2012)

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VBAC
What is VBAC?
VBAC means Vaginal birth after cesarean (VBAC) where a woman decides to have a
birth through the vagina after undergoing a previous caesarean section (Dickerson, 2010).
Sometimes women opt to have a caesarian section to have a baby; consequently while having the
second or next baby they opt for virginal birth. This practice leaves the mother confused as they
fear the risks that may occur in case of any complications. Mothers should therefore be clearly
informed of the choices they make to an informed consent or refusal. As Baxter & Davies,
(2010) states “The place of birth is also a critical issue, and many practitioners may be
concerned at the prospect of a woman with identified risk factors planning childbirth anywhere
other than in a fully equipped unit.” VBAC is linked to Trial of labor after cesarean (TOLAC).
TOLAC is the choice of a woman to labor and go for vaginal delivery after previous pregnancies
done by caesarian.
What are the risks versus benefits of doing VBAC versus C-section, after having a previous C-
section? Long-term versus short-term?
Women prefer VBAC due to experiences during prior births, medical recommendations,
social obligations and/or personal expectations. The major risk of VBAC that is debated is the
unsuccessful trial of labor that demands an emergency caesarian section (Baxter & Davies,
2010). This ill in turn contribute to hysterectomy and expose the patients to other risk associated
with surgery. Such risks include injury to uterus, bladder or other adjacent organs, anesthesia
complications, subsequent fertility issues, and thrombosis of pelvis (Dickerson, 2010).

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VBAC also exposes the woman to uterine rapture that causes hemorrhage and blood loss;
in addition it may cause perinatal death, a failed Trial of labor after cesarean (TOLAC) and a
possible episiotomy or vaginal laceration (Dickerson, 2010). Dickerson continues to state that the
rates of VBAC have continued to fall with more women preferring a second caesarian rather than
be exposed to the risks involved. He states that this is linked to physicians, preference of the
patients, and guidelines that are conservative in regards to emergent care.
Uterine rapture can be impacted by many variables which include induction of labor,
previous scars, maternal age, the number of caesarean done previously, and the interval between
the pregnancies. This will constitute the rapid response of an obstetric emergency due to
hemorrhage (Dickerson, 2010).
The benefits include less overall time to recover; this means that there is less time to stay
in the hospital. The baby’s lungs are seen to clear during the birth process and hence VBAC is a
better beneficial in this. The woman also reduces the risks of infections during the caesarian and
also other risks that come with it (Dickerson, 2010). There is also decreased mortality, morbidity
and including the rehospitalization of the patient. The neonatal risks involved include infections,
fetal mortality, asphyxia, laceration, birth injury, head hemorrhage and celebral palsy.
As McGrath, et al. (2010) states “A decreasing number of women are attempting VBAC,
despite ample evidence that the practice is predominantly safe for mother and baby”: This means
that mothers still view VBAC as risky despite its benefits, the recommendation would be to
always consult a physician to establish the facts before making any decision to avoid making
them based on the wrong basis. Safety during birth is paramount and hence ensuring that the
mother is safe and all emergency equipment is available at birth is the first step to guarantee a
successful birth.

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Reference
Baxter, L. & Davies, S. (2010). Balancing risk and choice in childbirth after caesarean section.
British Journal of Midwifery. 18 (10): 638 – 643
Dickerson, T. (2010). The Rise and Fall of VBAC in the United States. Journal of Legal Nurse
Consulting. 21 (1): 3 – 8
McGrath, P., Phillips, E., & Vaughan G. (2010). Vaginal birth after Caesarean risk decision-
making: Australian findings on the mothers’ perspective. International Journal of
Nursing Practice. 16: 274–281