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VBAC: Is It The Right Choice For You?

18 July 2014 by Hugh Larson

Many women who have had a caesarean section, or c-section for short, wonder whether they can deliver their next baby vaginally. In some circles, a rousing debate can ensue over this topic, and misconceptions abound on both sides. For example, some people insist that VBACs are unsafe and illegal, and others insist that vaginal birth after c-section is safe in all cases. The fact is, whether you can safely have a VBAC depends on individual circumstances. Here are some things to consider.

Legality

VBAC is not illegal in any state, according to VBACFacts.In fact, a woman can give birth anywhere at all, whether or not she has had a c-section, and she will not be breaking the law, assuming she has the right to be in that place to begin with. What may be illegal, however, is for certain birth attendants to be present for a VBAC. For example, in some states, it is illegal for a midwife to attend the homebirth of a woman who has previously given birth by caesarean section. In others, it is illegal for a birthing center to permit a woman to birth vaginally.

Some obstetricians, midwives or hospitals may tell women that VBAC is illegal, but what they actually mean is that it's against their policies to attend or allow this type of delivery. If you have your heart set on a VBAC and the reason that your doctor says no is that it's illegal, you can look into what the law actually says and determine whether the policy in question is that of the doctor or of the hospital.

Risks of VBAC

The primary risk of having a vaginal birth after caesarean is that the uterus will rupture. This is a very rare occurrence; it's estimated that a rupture occurs in about one out of 500 women. If uterine rupture did occur, there could be massive blood loss, and an emergency hysterectomy as well as other surgery might be necessary. Another consideration is that woman are at higher risk of infection if a trial of labor after caesarean section fails and a repeat c-section is needed.

Risks of Repeat C-Section

A c-section is major abdominal surgery, and there are risks involved. They include a risk of infection, injury to the bladder or bowel, problems with the anesthesia, blood clot development and the possibility of the baby having respiratory distress (due to not going through the birth canal and having the chest compressed in the process). According the the American Pregnancy Association, repeat c-sections can be riskier than first-time c-sections.

Homebirth After Caesarean

Some midwives offer to attend homebirths after c-sections, also called HBACs. A lack of unnecessary intervention might make labor proceed more smoothly and reduce the risk of a repeat c-section. On the other hand, if a uterine rupture or other emergency were to occur, you would not be in a hospital at that moment, and a transport to the ER would be necessary. In rare cases, this could mean the difference between life and death. Your midwife, possibly along with a medical doctor, will evaluate your case to make sure that homebirth is a safe option for you.

Contraindications to VBAC

In some situations, a VBAC is simply not a good option. For example, if you are diabetic or have gestational diabetes, your baby may be born very large. This is a risky situation to begin with, and your doctor will almost certainly tell you that a VBAC is not a feasible option. Also, if you are pregnant with twins or if your baby is breech, you will most likely be scheduled for a repeat c-section. If you had your first caesarean due to anatomical reasons that would preclude vaginal delivery, then you would need to have another caesarean section.

The Bottom Line

If you are considering a VBAC, it's vital to be in close contact with your doctor or a midwife from a company such as http://www.whallc.com in order to make sure that you are a candidate for a healthy vaginal delivery. While you should not feel pressured into abandoning your wishes for a vaginal birth simply due to hospital policies, it is important to listen carefully to the reasons given and to follow your healthcare provider's recommendations based on your health and individual circumstances.

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