Vaginal birth after C-Section (or VBAC) has become a very controversial topic in Obstetrics both for physicians and patients. We wrote about it in our book, “The Mommy Docs’ Ultimate Guide to Pregnancy and Birth” and in the book, Dr. Hill writes that she would never jeopardize the health of her baby by having a vaginal delivery after having a c-section. She would rather have a repeat c-section to insure no undue trauma to her baby. She was open and honest with her opinion, and she also wrote that if it was a patient’s desire to have a VBAC, she would honor and respect that.
Once a woman has a cesarean section she has two options for her next birth. One is to schedule a repeat cesarean at 39 weeks (or earlier if she goes into labor or has an obstetric complication requiring delivery) or the second option is to attempt a vaginal birth after cesarean section, commonly known as a VBAC.
The first option is pretty straight forward – you set a date with your obstetrician and come in for an elective surgery. There are minimal risks to the baby by having an elective C-section as long as it is done at 39 weeks or later. Babies who are born at less than 39 weeks have a higher risk of a condition called transient tachypnea of the newborn, an issue where the baby has difficulty breathing after delivery because of extra fluid in the lungs. This occurs more frequently in cesarean birth because during vaginal delivery the fluid is squeezed out of the lungs during the passage through the vaginal canal.
For the mother there are surgical risks from cesarean which include: wound infection, bleeding, and damage to organs surrounding the uterus such as the bladder and intestines. Also with each cesarean there is increased risk for potential scar tissue formation making each subsequent cesarean more difficult.
There is also increased risk of placental problems, placenta previa (where the placenta crosses the cervix ) and placenta accreta (where the placenta doesn’t detach properly from the uterus) with each cesarean. Most doctors do not recommend that a woman has more than four C-sections because of these risks.
There are also significant risks associated with VBAC. The biggest risk is that the scar on the uterus from which the baby was delivered from the prior cesarean can tear open or rupture. The risk of this is 0.7 percent with one prior cesarean. The risk increases with each subsequent C-section. If this happens the baby can be extruded into the abdomen causing both mother and fetus to hemorrage, and, in the worst case, maternal or fetal death.
In less severe cases, the uterine scar may be torn open but the baby is still within the uterus. This damage to the uterus can cause increased bleeding during the surgery and more difficult repair of the uterus. The advantages to doing a VBAC over a repeat cesarean are decreased postoperative pain, easier mobility and a quicker return to daily activities like caring for a newborn or toddler. Also, the ability to have more children safely is an added benefit.
In our practice, all three of us support and care for women who choose to have a VBAC. We all know that there is a risk associated with VBAC and wouldn’t choose it personally. In fact, Dr. Hill was criticized by someone who read our book and said that she made women feel guilty by saying that they should not risk the life of the baby to accomplish this. We understand it’s a personal and very emotional decision, but as doctors we only want what’s best for the health of the mom and baby.
Once again, our professional opinions are based on the fact that moms and babies have almost died going through the process and as doctors, we do not think the risk is worth it, but we are open to women who have a different need to experience this. A VBAC is a serious undertaking and must be done in the safest of circumstances, in a hospital where a NICU, an anesthesiologist and an obstetrician are available at a moment’s notice. If these conditions are not available, it is not worth the risk.