Vaginal Birth After Cesarean (VBAC)

In the past, it was thought that once a woman had a cesarean birth, all babies she had afterward also had to be born by cesarean. That thinking has changed. Today some women who have had a cesarean birth are being allowed to try a vaginal birth with later pregnancies. If no other risk factors are present with your next pregnancy you may be allowed to try a vaginal delivery. Other risk factors include problems with the placenta, your baby, or you have other medical conditions.

When deciding how your next baby will be born, your wishes and certain medical factors will be considered. A key factor in deciding the method for your next birth is the type of incision made in your uterus for this cesarean. The type of incision used for your cesarean birth was decided by your doctor based on many factors. These factors include reducing health risks for you and your baby. Rupture of the uterus where the incision was made is the main risk to both you and your baby during an attempted vaginal birth after cesarean. Depending on the type of incision made, you may have a higher risk of your uterus tearing or rupturing where the incision was made. The risks of rupture is different for each type of incision.

Incisions in uterus for cesarean birth
The classical incision (high vertical incision) is an up-and-down cut made in the upper part of the uterus. Unfortunately, a complete tear or rupture of the scar is more likely during a future vaginal birth if this type of incision was made.

The low vertical incision is an up-and-down cut made in the lower, thinner part of the uterus. The risks with vaginal birth after this type of incision are not clear. If you had this type of incision, ask your doctor about your future options for vaginal birth.

The low transverse incision is made from side-to-side across the lower, thinner part of the uterus. It heals with a stronger scar and is the least likely to rupture, tear, or cause problems in a future vaginal birth.

The type of incision made in the skin of the abdomen (up-and-down or side-to-side) is not always the same as the type of incision made in the wall of the uterus. You can’t tell what type of incision was made in your uterus from looking at the scar on your abdomen. Knowing what type of incision you have can help you prepare for a cesarean or vaginal birth with your next pregnancy. However, without your medical records, it is unlikely that your doctor will know which type of incision was made in your uterus. Get a copy of your prior medical records if you are considering VBAC.

More About Self Care After Cesarean Birth

Introduction to Self-care After Cesarean Birth
Preventive Self Care
Perineal Care
Physical Changes and Healing
Vaginal Birth After Cesarean (VBAC)
Breast Care
Activities and Healthy Exercise
Nutrition and Diet
Family Planning and Birth Control
Normal “Baby Blues” or Postpartum Depression
Your Postpartum Check-Up
Get as Much Rest as You Can
When to Call Your Doctor

VBAC moment
Posted by mom as “VBAC moment – Victorious Birth After Cesarean” 6-10-2010

Elective repeat C-sections have become increasingly common and now represent about 40% of the 1.3 million cesareans performed each year in the USA, the researchers note in The New England Journal of Medicine.

July 2010—The new guidelines from the American College of Obstetricians and Gynecologists say that women who have had two previous C-sections or are carrying twins are appropriate candidates for vaginal birth after cesarean, known as a VBAC. The group had previously said women with one previous C-section were candidates, and was less clear on other women.

The risk of uterine rupture during VBAC is 1% to 2%.

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