Vaginal birth after caesarean

Vaginal Birth After Caesarean

Vaginal Birth After Caesarean (VBAC) refers to the process of giving birth vaginally after a previous pregnancy was delivered via caesarean section. This option is considered by many women who wish to experience a vaginal delivery and avoid the risks associated with multiple caesarean deliveries.

Background

The concept of VBAC emerged as a response to the increasing rates of caesarean deliveries worldwide. Historically, once a woman had a caesarean delivery, subsequent deliveries were also performed via caesarean due to concerns about uterine rupture. However, research and advancements in medical practices have shown that many women can safely attempt a vaginal delivery after a caesarean.

Benefits

VBAC offers several benefits, including:

• Reduced Recovery Time: Vaginal deliveries typically have shorter recovery periods compared to caesarean sections.
• Lower Risk of Surgical Complications: Avoiding surgery reduces the risk of infections, blood loss, and other surgical complications.
• Decreased Risk in Future Pregnancies: Multiple caesarean sections can increase the risk of complications in future pregnancies, such as placenta previa and placenta accreta.

Risks

While VBAC can be a safe option for many women, it is not without risks. The primary concern is the risk of uterine rupture, which can be life-threatening for both the mother and the baby. Other risks include:

• Failed Trial of Labor: Some women may not progress in labor and require an emergency caesarean.
• Increased Risk of Infection: If a caesarean becomes necessary after labor has begun, the risk of infection may be higher.

Eligibility Criteria

Not all women are candidates for VBAC. Factors that may influence eligibility include:

• Type of Uterine Incision: A low transverse incision is generally considered safer for VBAC than a vertical incision.
• Number of Previous Caesareans: Women with multiple previous caesareans may face higher risks.
• Reason for Previous Caesarean: If the reason for the previous caesarean is not likely to recur, VBAC may be more feasible.

Management and Monitoring

Women attempting VBAC should be closely monitored during labor. Continuous fetal monitoring is often recommended to detect any signs of distress. Access to emergency surgical facilities is crucial in case a caesarean becomes necessary.

Success Rates

The success rate for VBAC varies but is generally around 60-80%. Factors that can increase the likelihood of a successful VBAC include a previous vaginal delivery and the absence of recurrent indications for caesarean.

Also see

• Caesarean section
• Uterine rupture
• Trial of labor
• Obstetrics