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Beginnings: Pregnancy, Birth & Beyond

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Second trimester: Vaginal birth after a Cesarean

If you have already had an emergency or planned Cesarean, you may be able to attempt a vaginal birth with this baby. This birth is known as a VBAC.

The decision will be one that you and your health care provider will make together.

These are guidelines for VBAC, according to the American College of Obstetricians and Gynecologists:

  • you had a low-transverse uterine incision from one previous Cesarean birth (If the scar is on the upper part of your uterus, you should not try to have a VBAC.)
  • your uterus does not have scar tissue or it has not ruptured
  • the size of your pelvis is wide enough to attempt a vaginal birth and you have not had any pelvic problems
  • you have no other restrictions.

You should not attempt a home vaginal birth. The American College of Obstetricians and Gynecologists recommends that a surgeon, nurses and an anesthesiologist are immediately available in case an emergency Cesarean is needed.

Reasons to consider a VBAC

A vaginal birth may benefit you and your baby, according to the American College of Obstetricians and Gynecologists.

For you:

  • no major abdominal surgery
  • a shorter hospital stay
  • lower risk of infection
  • lower need for a blood transfusion
  • quicker recovery
  • easier time breastfeeding.

For your baby:

  • easier to breathe (fluid is pushed out of the baby's lungs when coming through the birth canal)
  • contact with you right after birth
  • able to breastfeed right away.

Risks of a VBAC

You and your health care provider should review the benefits and risks of a VBAC and consider what is best for you. He or she will fully explain the risks with you.

Risks can include:

  • The uterine scar from a previous Cesarean may separate or tear. Or, your uterus may rupture (open).
    • A ruptured uterus is life-threatening. You would need an emergency Cesarean birth.
    • A ruptured uterus could also lead to a hysterectomy. This is surgery to remove the uterus.
  • Surgery to deliver a baby by Cesarean is major surgery. Ask your health care provider about the risks (such as infection, blood loss or clots, injury to your uterus and the placenta, and anesthesia problems).

It is important that you understand what services are available at the hospital in case you need an emergency Cesarean.

Ask your health care provider how the hospital staff will respond to an emergency during your labor. Ask what services are provided, what resources are available, and who will be on your health care team.

Pain control

You have options to control pain during a labor and vaginal birth. The most common option is a labor epidural. The doctor inserts a small catheter (thin plastic tube) into your lower back. The tip of the catheter rests in the area just outside the spinal cord. This area is called the epidural space. Medicines to control labor pain are given through the catheter.

Your health care provider will explain the benefits and risks of a labor epidural. He or she can explain other pain control options that are available. Together, you and your health care provider can create a pain management plan before your delivery.

Your feelings

You may have mixed or negative feelings about giving birth vaginally.

You may be afraid to attempt labor, not knowing what to expect. You may favor a Cesarean because you know what to expect. If your last birth started with labor and ended with a Cesarean, you may not want to go through labor again.

Remember, each pregnancy and labor is different. In deciding if a VBAC is right for you, your health care provider will take your specific health into account.

Childbirth and VBAC classes can help answer your questions. For more information, call Allina Health Class Registration at 612-262-3333.


 

Source: Allina Health's Patient Education Department, Beginnings: Pregnancy, Birth and Beyond, sixth edition, preg-ahc-90026, ISBN 1-931876-25-8

First published: 10/04/2002
Last updated: 08/22/2011

Reviewed by: Allina Health's Patient Education Department experts