Asked by Anne, Gainesville, Florida
I'm pregnant with my third baby and am due next month. I had C-sections with the first two babies but would like to try having the baby naturally this time. People have told me that this is not safe, but I found an obstetrician who is willing to do a VBAC. What's the latest information on having a vaginal delivery after having a C-section?
Living Well Expert
Dr. Jennifer Shu
Children's Medical Group
Thank you for your question. Many women who have had cesarean sections inquire about the possibility of attempting a vaginal birth after C-section (VBAC), sometimes also called trial of labor after C-section (TOLAC). To better help you, I consulted Dr. Gary Glasser of Atlanta Gynecology and Obstetrics in Decatur, Georgia.
Glasser shares the following information:
This is a very timely subject, as guidelines concerning vaginal birth after cesarean (VBAC) were updated in August by the American College of Obstetrics and Gynecology. In the past, the dictum was "once a cesarean, always a cesarean," and the cesarean section rate increased for this and other reasons during the 1970s and '80s. The 1990s saw a renewed interest in attempting VBACs, and the cesarean section rate dropped. But as the rate of delivery complications from VBAC (including uterine rupture) increased, attempts at VBAC decreased, although there are some benefits to avoiding repeated cesarean sections.
The current thought in the American College of Obstetrics and Gynecology guidelines, therefore, is that a trial of labor after cesarean delivery is "a reasonable approach in selected pregnancies."
For patients with a previous cesarean, a successful VBAC has fewer complications (those associated with major surgery) than a scheduled cesarean. Multiple cesareans can increase the risk of injury to other surrounding organs, the need for a hysterectomy and the chances of requiring a blood transfusion.
However, VBAC is not risk-free. VBAC increases the risk of uterine rupture (reported to be between 1 in 100 and 1 in 200), which can be sudden and catastrophic for both mother and baby. Both a successful VBAC and a scheduled cesarean, however, have fewer complications for both the mother and the baby than a failed trial of labor after cesarean.
Women who are good candidates may therefore be advised to attempt a VBAC if the chance of success is high. Overall, the success rate is about 60% to 80% and depends on many factors (such as the type of uterine incision and the reason for the previous cesarean, among others). As new data have become available, more patients are eligible for the possibility of an attempted VBAC, including patients with two previous cesareans and those with a previous cesarean section who are currently pregnant with twins.
There is no formula or algorithm that fits every patient. A thorough discussion with your health-care provider is essential to get the most up-to-date and personalized information about the risks and benefits of attempting a VBAC.
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