Because most of the women I know who have had c-sections had not planned or wanted to give birth in that fashion, VBAC is also very high in our consciousness. For my friends with one child (so far), whose long labors or other circumstances led to unplanned, emergency, or unwanted-but-scheduled c-sections, my "achievement" of a successful VBAC is something I'm very happy to talk to them about and that I am often asked about. This post, then, is not so much about numbers and stats, although I will put some for everyone's own edification. This post is about why I wanted a vaginal birth and how that can still happen even if you've had a c-section (or two!) in the past.
I hope this is post is informational, emotional, and meaningful, and I hope that if you are on the fence about whether to consider or attempt a VBAC, this post helps you decide.
Let's start with some basics. In almost all cases (except for those in which c-section is necessary to save the life of mother and/or baby), vaginal birth is safer than c-section for both mother and baby. I listed some of the risks of cesarean section in the previous post. Certainly, there are risks associated with vaginal birth, as well, but these are typically less severe or less common than any of the complications or risks associated with cesarean birth.
Additionally, the recovery from a vaginal birth is generally considerably shorter, easier, and less painful than recovery from a c-section. Most women are up and about after just a few days following a vaginal birth. The typical hospital stay is 24 to 48 hours following a vaginal birth, compared to 72 to 96 hours following a c-section. Yes, there may be pain from vaginal or perineal tears or episiotomy upon sitting or using the bathroom. The abdominal area may be tender. There may be painful uterine cramping (as there would be following a c-section anyway). But because you have not experienced major surgery from which your body is attempting to recover, you will likely be surprised at the ease with which you are able to recover from the vaginal birth as compared with the c-section.
In July 2010, the American Congress of Obstetricians and Gynecologists (ACOG) issued a practice bulletin stating a desire for less restrictive guidelines for VBAC. VBAC is considered safer than cesarean delivery in most cases for women with one or two previous cesarean births. ACOG recommends allowing women a Trial of Labor after Cesarean (TOLAC) in most cases, if desired.
The most common risk cited in argument against VBAC is the possibility of uterine rupture, in which the uterine wall opens up during labor. This can be, but is not always, a catastrophic emergency, sometimes resulting in emergency hysterectomy. However, uterine rupture does not always lead to hysterectomy or even future infertility, although it does require emergency intervention in the OR. Most importantly, the chance of uterine rupture is less than 1% of all VBACs! Most major risks associated with repeat cesarean are statistically higher than the risk of uterine rupture during a trial of labor.
I mentioned in my previous post that I am most concerned with the non-medical risks of cesarean section delivery. These are mostly the emotional consequences of not experiencing the desired birth scenario. Many women feel that their bodies have failed them, or that they have missed out on something very special. These feelings can lead to postpartum depression and/or delayed bonding with the new baby. In addition, depending on the environment in which the c-section is performed, there is often a delayed initiation of breastfeeding. Plus, the pain and long recovery time associated with c-section can interfere with breastfeeding as well, sometimes leading to formula supplementation and/or breastfeeding cessation. This, in turn, can lead to further emotional consequences for the mother and continue the disruption of the bonding process between mother and baby.
I know this because I went through it, and I have spoken with many other women who have experienced these same feelings. (That's not to say every woman who has a c-section feels this way, or that every woman who has had a c-section has any difficulties with breastfeeding, or that any woman that does not breastfeed or stops breastfeeding experiences these feelings of betrayal, failure, guilt, or anger.)
I think it's pretty obvious, then, why a woman who has experienced an unwanted c-section would want to attempt a VBAC should she decide to have another baby. Having a VBAC can be incredibly healing. It's a way of saying, "Yes, my body can do this."
Approximately 60 to 80% of attempted VBACs result in a vaginal birth. This means your "odds" of success are quite good.
You are a good candidate for VBAC if:
- You have had one or two previous cesarean deliveries using a low transverse (bikini) incision. If you are not sure what kind of incision you had, you should ask your doctor. The vast majority of c-sections performed these days utilize a low transverse incision.
- You have a healthy pregnancy.
- You do not have any conditions that would render vaginal birth unsafe, such as placenta previa, placental abruption, prolapsed cord, breech baby.