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What is Vaginal Birth After C-Section (VBAC)
As the name suggests, a VBAC is the choice and process of delivering a baby vaginally even if the previous birth was a cesarean. All doctors and medical experts suggest that a woman should give birth naturally, unless she wants to or has to choose a C-section as there are many benefits of a vaginal birth over C-Section.
Many women are under the impression that if she has undergone C-Section in her previous pregnancy, she will always have to give birth the same way. However, that is not true. Most women can give birth vaginally after a C-Section. According to Dr. Alka Gujral, 90% of women are eligible for a vaginal delivery after a cesarean delivery. So, “Once a cesarean, always a cesarean” is absolutely not true. If a woman goes into spontaneous labour, chances of vaginal birth after C-section is very high but if it is an induced labour the chances decrease drastically.
Factors that affect vaginal birth after C-Section
#1. What was the main reason for the woman to have undergone C-section in the previous pregnancy?
It is important for a doctor to know why there was a need for a C-Section delivery the previous time. Was it her choice or because of a complication that urgently required a cesarean delivery. Understanding the woman’s history will better prepare the doctor for planning in present pregnancy.
#2. Is it a recurring factor?
It is also important to find out why the woman has not been able to give birth naturally. Have all her previous deliveries been cesarean? Is it a recurring pattern? Is it because she has small bones? Was it because the baby’s head or body was too large to pass through the mother’s pelvis? All of these things have to be taken into consideration when trying to deliver naturally.
#3. Was there a problem in the cervix?
Was there any sort of complication or abnormality in the cervix that lead to a cesarean birth in the past? If yes, what was the complication? Was it because of a surgery prior to pregnancy?
#4. What was the woman’s age?
Age can also play a huge role in a cesarean delivery. The older the woman is, the harder it is for her to deliver vaginally.
#5. History of surgeries
If a woman has had several surgeries done in the past like removing fibroids doing an abortion with a cut in the uterus, uterine rupture in the previous pregnancy, she may not be able to give birth naturally.
#6. Other problems
If the woman is obese, has high blood pressure, develops diabetes during the course of her pregnancy, or the baby is too big or is in an unfavourable position, she may not be able to have a vaginal delivery. If in the past, a woman has given birth via a lower segment C-Section, she can give birth normally. If she had an upper segment C-section in the past, she will have to choose a C-section birth again.
Dangers and risks of vaginal birth after C-section
The biggest risk of VBAC is uterine rupture. If the pregnancy is normal one and labour is spontaneous, the chances of uterine rupture is extremely low. Less than 2% of women (1 in 500) experience a uterine rupture, if the pregnancy is a normal one. However, if labour is induced, the chances of a uterine rupture may increase to upto 5%. This percentage also depends on the method used to induce labour.
If uterine rupture does occur, the woman and her healthcare provider must be extra cautious. She should ideally be placed in a facility that is well-equipped with everything she might need in order to safely deliver the baby and for a speedy recovery. Because of a uterine rupture, one may also have to go through a hysterectomy to stop the excessive bleeding.
What is inter-delivery interval?
Inter-delivery interval is the ideal gap or preferred time period between the first pregnancy and the second one. If there is a gap of less than two years, the chances of uterine rupture are 2.7% but if it more than 2 years, it is 0.9%.Hence, doctors generally advise women to take at least a two year gap.
Precautions to take for Vaginal birth after C-section
- A pregnant woman must keep a check on her weight. If she is obese, it will only create further complications for her. Obesity also leads to high blood pressure and high blood sugar.
- If the pregnancy is going to be high-risk, the woman might need an induction of labour.
- Eat a healthy diet. Cut off from junk food, smoking and all forms of alcohol.
- Curb problems in the initial stages as it may turn into a high risk pregnancy.
- Engage in mild forms of exercises like brisk walks and yoga for pregnant women.
- Prepare yourself and your family mentally and physically for a normal delivery. More and more women are getting scared of normal deliveries as they are not mentally prepared.
If the first delivery is C-section, does the type of hospital for the latter delivery matter?
Yes, choose a trusted and well-reputed hospital with round the clock facilities. It should have an operation theatre facility, availability of anesthetics, availability of anesthesia, availability of trained nursing staff and good number of junior doctors as well. It is important to choose a large-scale hospital as a smaller, local nursing home do not have the proper facilities to cater to a high-risk delivery.
Benefits of normal delivery
- One must keep in mind that c-section is a surgical procedure in which one has to face all the risks of a surgery. Risks include anesthesia, any sort of injury to your organs as this is a possibility in any kind of surgery.
- In a normal delivery, recovery is very fast and hospital stay is also of lesser duration.
- If someone wants to have a big family and wants many children, a C-section delivery is not the right option her. With C-Sections, there will be a lot of scarring, and adhesions between the bladder and the uterus or other structures like the intestines. If one is choosing a C-section each time, it will endanger the life of the woman and leads to problems like bladder and bowel injury.
- The mother and baby bond better as she breastfeeds faster. There is earlier skin to skin contact with the mother. However, one should also keep in mind that it is not the immediate bonding that really matters, what matters most the long-term bond that forms over a period of time.
- During a vaginal delivery, oxytocin, a hormone that comes from the pituitary gland is released into the blood which aids in breast let down and some emotional changes as well.
- The release of oxytocin supposedly makes a woman go into what is called an “euphoric phase” which decreases the chances of postpartum depression.
Before deciding on what type of delivery the mother prefers, it is important for the doctor to go through all her previous records and pregnancy to come to a conclusion. It is also important to prepare the mother for a vaginal birth mentally. Some people are unaware that they can still have a vaginal birth after c-section. The mother has to take good care of herself, not put on too much weight, doctor has to identify problems early on if there are any. The earlier a problem is identified, the easier it is to curb it or treat it completely for a normal kind of delivery.