Categories: Health

What is a VBAC?

What is a Vaginal Birth After Caesarean (VBAC)?

A vaginal birth after caesarean (known as a VBAC) is when a woman who has had a caesarean has a vaginal birth down the track. In Australia, about 12% of women have a vaginal birth for a subsequent baby after a caesarean.

What Happens? What are the Risks?

When a woman chooses a VBAC, she is cared for much like she would during a planned vaginal birth. However, an induction of labour is avoided as much as possible, due to the slightly increased risk of the caesarean scar opening up (known as uterine rupture). This is because the medication used in inductions can stimulate strong contractions that put a greater strain on the scar.

One of the main reasons women may be recommended to have a repeat caesarean over a vaginal birth is due to an increased chance of her caesarean scar rupturing. This is when layers of the uterus (womb) separate and an emergency caesarean is needed to deliver the baby and repair the uterus.

Uterine rupture is rare, occurring in about 0.2-0.7% of women with a history of a previous caesarean. However, uterine rupture is a medical emergency. A large European study found 13% of babies died after a uterine rupture and 10% of women needed to have their uterus removed.

Why Avoid Multiple Caesareans?

There are also risks with repeat caesareans. These include slower recovery, increased risks of the placenta growing abnormally in subsequent pregnancies (placenta accreta), or low in front of the cervix (placenta praevia), and being readmitted to hospital for infection.

Women reported birth trauma and post-traumatic stress more commonly after a caesarean than a vaginal birth, especially if the caesarean was not planned. Women who had a traumatic caesarean or disrespectful care in their previous birth may choose a VBAC to prevent re-traumatisation and to try to regain control over their birth.

We Looked at What Happened to Women

The most common reason for a caesarean section in Australia is a repeat caesarean. Our new research looked at what this means for VBAC. We analysed data about 172,000 low-risk women who gave birth for the first time in New South Wales between 2001 and 2016.

We found women who had an initial spontaneous vaginal birth had a 91.3% chance of having subsequent vaginal births. However, if they had a caesarean, their probability of having a VBAC was 4.6% after an elective caesarean and 9% after an emergency one.

What Increases the Chance of Success?

When women plan a VBAC, there is a 60-80% chance of having a vaginal birth in the next birth. The success rates are higher for women who are younger, have a lower body mass index, have had a previous vaginal birth, give birth in a home-like environment or with midwife-led care.

For instance, an Australian study found women who accessed continuity of care with a midwife were more likely to have a successful VBAC compared to having no continuity of care and seeing different care providers each time.

Why is this Important?

With the rise of caesareans globally, including in Australia, it is more important than ever to value vaginal birth and support women to have a VBAC if this is what they choose. Our research is also a reminder that how a woman gives birth the first time greatly influences how she gives birth after that. For too many women, this can lead to multiple caesareans, not all of them needed.

Conclusion

VBAC is a safe and effective option for many women who have had a previous caesarean. While there are risks involved, the benefits of a vaginal birth far outweigh the risks. Women who choose a VBAC are more likely to have a shorter recovery time, less pain, and a lower risk of complications. With the right care and support, many women can have a successful VBAC and a positive birth experience.

FAQs

Q: What is the success rate of VBAC?
A: The success rate of VBAC is around 60-80%.

Q: What are the risks of VBAC?
A: The main risk of VBAC is uterine rupture, which is rare and occurs in about 0.2-0.7% of women with a history of a previous caesarean.

Q: Who is most likely to have a successful VBAC?
A: Women who are younger, have a lower body mass index, have had a previous vaginal birth, give birth in a home-like environment or with midwife-led care are more likely to have a successful VBAC.

Q: What is continuity of care?
A: Continuity of care refers to the provision of care by the same healthcare provider throughout a woman’s pregnancy, birth, and postpartum period.

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