The Truth about VBAC: Vaginal Birth After Cesarean

What is VBAC?

VBAC stands for Vaginal Birth After Cesarean. If you’ve previously delivered with a cesarean section, and you want to give birth again, there are two options: a scheduled delivery with cesarean section, or a vaginal delivery. This vaginal delivery after you’ve previously delivered via cesarean section is called VBAC.

When you’re weighing your options, and decide to have another child via vaginal delivery, you’re interested in trying for a trial of labor after cesarean (TOLAC). TOLAC is just the attempt of the vaginal birth. VBAC is when the successful vaginal delivery takes place.

In the United States, the VBAC success rate is between 60-80%. Here at BJU over our 15 year history, we have had a VBAC success rate of 72%. And in 2012, that success rate was about 90%.

Advantages

Women who give birth vaginally have a faster recovery rate after birth, thereby having a shorter hospital stay. They’re able to return quicker to normal activities because there is no pain from surgery. Vaginal deliveries have less chance of needing a blood transfusion, less risk of infection, and non problems potentially caused by surgery. There’s less risk that the baby will have breathing problems. They’re also more likely to have vaginal birth in later pregnancies, and can also avoid the risks that are possible with multiple cesarean sections.

Risks

The biggest risk associated with TOLAC is a tear in the uterus from the previous cesarean. If a tear were to occur, risks include blood loss and may necessitate a transfusion, damage to the uterus that may require a hysterectomy, bladder damage, infection, blood clots, and in very rare cases, death of the infant or mother. Also, if for some reason a vaginal birth cannot occur, a cesarean section is required. Cesarean delivery after labor has started carries a double risk of infection than if done before labor starts.

Should I try for TOLAC?

In China, we’re in a special situation due to the One-Child Policy; many women come in and say, “Since this will be my only pregnancy, I might as well just get a cesarean and bear myself the pain.” However, there are more and more women in China having second children, and international patients often come to hospitals like United Family for second and multiple births.

A woman’s medical and prenatal history is important when considering TOLAC. Where was the uterine incision? Women with low transverse incisions, the most common cesarean incision, are the least likely to have a rupture, while vertical incisions carry a greater chance. Vertical incisions high on the uterus have the greatest chance of rupture, and are generally not considered candidates for TOLAC. Also consider when you had your last pregnancy. Deliveries closer than 18 months apart increase the risk for an unsuccessful VBAC. Increased age and high body mass of the mother, high birth weight of the baby and pregnancy beyond 40 weeks of gestation will also decrease the chance for a successful VBAC.

The success rate for VBAC is decreased if there is a need to induce labor. Women who have had a prior vaginal delivery are more likely to have a successful TOLAC and VBAC.

How does BJU guide and monitor pregnant moms through their pregnancy and labor?

At Beijing United Family Hospital (BJU) we are proud to emphasize that our patients’ choice is always respected. We are prepared to consult each patient regarding the risks and benefits in every specific case, and provide the safest environment possible. When considering your options, you need to know the risks and weigh them against the benefits.

Our professional OB/GYN staff is readily trained to handle emergency situations, should they arise. We pride ourselves in handling emergency deliveries and in providing good consultation beforehand so patients feel well-informed.